ࡱ> egd%` \bjbjNN 8^,,Y  L` 0Piii+0-0-0-0-0-0-0$2h4zQ0iQ0f0WWW8+0W+0WW+h,D B[,-<|000k,|t5dt5 ,t5,ivTW3Dw@iiiQ0Q0Giii0           Organic Reaction Mechanism GroupThe completed form should be returned to ŷAV Conferences: ŷAV Conferences, Thomas Graham house, Science Park, Milton Road, Cambridge, CB4 0WF, UK. Fax: +44 (0) 1223 423623, email: conferences@rsc.orgPlease use this form to register for the day delegate rate onlyConference Title Castleton POC Residential MeetingDates of conference5 7th June 2009 Day Delegate Rate: 100 APPLICANT DETAILSTitle Mr  SHAPE \* MERGEFORMAT  Mrs  SHAPE \* MERGEFORMAT  Miss  SHAPE \* MERGEFORMAT  Ms  SHAPE \* MERGEFORMAT  Dr  SHAPE \* MERGEFORMAT  First NameSurnameŷAV Membership NumberPlace of Study/WorkAddressPostcodeCountryTel / FaxEmailPAYMENT DETAILS  SHAPE \* MERGEFORMAT  I would like to pay by credit card 100MASTERCARD/VISA/AMERICAN EXPRESSCard Number: Expiry Date:Cardholder Name: Mailing Address:  SHAPE \* MERGEFORMAT  I would like to pay by cheque 100Signed: Date: Terms & Conditions and Data Protection No reservations for attendance will be made if payment is not received prior to the start of the event. Cancellations received before the cancellation deadline, 22nd May, will be subject to an administration charge of 25% of the total fees. 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