Registration Form To reserve a place for you for the Skin@Bath Network Symposium, please complete the below registration form to reserve your place.Registration, dinner and/or hotel fees are to be made payable to BIRD to confirm your place, BACS details below. Question Title * 1. Your details: Title First name Surname Role Organisation Email address Contact telephone Any dietary requirements: Any mobility requirements: Question Title * 2. Please select: I am a Healthcare Professional/Clinician I am an Academic/Researcher Other (please specify) Question Title * 3. Registration fees; Early bird discount for applications before 1st September 2024. EARLYBIRD Non-Students/Non-Medical Trainees - £140.00 per person EARLYBIRD Students/Medical Trainees/Retired colleagues - £60.00 per person Virtual attendance - £75.00 per person Industry colleagues - £500 per person. Alternatively, see our sponsorship options https://skinatbath.org/sponsorship/ Question Title * 4. Registration fees; For bookings received after 1st September 2024. Non-Students/Non-Medical Trainees - £200.00 per person Students/Medical Trainees/Retired colleagues - £85.00 per person Virtual attendance - £75.00 per person Industry colleagues - £500 per person. Alternatively, see our sponsorship options https://skinatbath.org/sponsorship/ Question Title * 5. Additional extras: Welcome Drinks Reception - Victoria Art Gallery - Wednesday 11th December 2024, 6.00pm - £0.00 Evening Dinner Reception - Guildhall Bath - Thursday 12th December 2024, 6.30pm - £60.00 per person Question Title * 6. Hotel requirements:Please select the below nights you would like to reserve.This is a budget friendly hotel, the Travelodge Bath Waterside. This hotel is approx. a 10 minute walk from the conference venue. Rate based on a double room with single occupancy. Deadline for hotel booking: Friday 1st November 2024. Wednesday 11th December (Weds) £80.00 pp pn Thursday 12th December (Thurs) £110.00 pp pn Friday 13th December (Fri) £122.00 pp pn Question Title * 7. Total payment due:Please include registration fees and any extras e.g. hotel, abstract book or dinner. Please make payment via BACS. Unfortunately we do not have an online payment system or credit card facilities. if you would prefer an invoice, please email us.Account name: Bath Institute for Rheumatic DiseasesBank: Unity Trust BankAccount no: 20363439Sort code: 60 83 01IBAN number: GB93 NWBK 6002 3571 4180 24SWIFT number: NWBK GB2LReference No: Please use the payment reference: D39 Skin2024 and your surnameForeign Payments - When making foreign payments to BIRD via Unity Trust Bank, the service is provided via NatWest or Western Union. Unity Trust only require the sort code and account number to be quoted when sending your payment with the IBAN & SWIFT numbers given above. Our sort code and account number are not included in our IBAN & SWIFT numbers. We cannot provide an alternative IBAN or SWIFT numbers - further information here ‘Receiving payments’ & ‘Important information about our Foreign services’. If you need any further information from us please don’t hesitate to get in touch. Cancellation Policy: Cancellations received before 1st August 2024 will receive a full refund. Cancellations received before 1st November 2024 will receive a 50% refund for registration fees, unfortunately hotel cancellations cannot be refunded after 1st November 2024. Cancellations received any later will not be eligible for a refund. Done