Southern Institute for
Health Informatics

2009 Conference

Patient engagement through innovation

Portsmouth

Friday 18th September 2009

SIHI 2009

Friday 18th September 2009
University of Portsmouth

 
SIHI 2009 home page
Register
Programme
Speakers
Call for participation
Infomart
Conference committee
Venue and directions
 

More info:

sihi@port.ac.uk
Tel: 023 9284 6445

Conference registration

Early bird discount applies to bookings on or before 1st September 2009!

Please use this form to register for the SIHI 2009 conference in Portsmouth on 18th September 2009.

If you prefer, a printable form can be downloaded in MS-Word or PDF format.

In order to encourage as many people as possible to attend, we have kept costs low and offer discounts for groups of attendees from the same organisation registering on the same form, and registering before 1st September.

* indicates a mandatory field

Please use Sentence case, not CAPITALS.

Name of company/organisation:

*

Delegates from that organisation:  

   
Registration submitted before
1st September 2009
Registration submitted on or after
1st September 2009
1 Title: Forename: Lastname: 
Jobtitle: 
@ £85.00
@ £95.00
2 Title:  Forename:  Lastname: 
Jobtitle: 
@ £85.00
@ £95.00
3 Title:  Forename:  Lastname: 
Jobtitle: 
@ £60.00
@ £70.00
4 Title: Forename: Lastname:
Jobtitle: 
@ £60.00
@ £70.00
5 Title: Forename: Lastname:
Jobtitle: 
@ £60.00
@ £70.00
6 Title: Forename: Lastname:
Jobtitle: 
@ £60.00
@ £70.00

Correspondence regarding this registration will be addressed to the first named person above

Please give their contact details:

Contact's full postal address*
Contact's email address:  *
Contact's telephone number:  *
Contact's fax number: 

Payment

There are three payment options. Please select the one you prefer.

cheque Please give me a registration form to print and I will send it to you with a cheque
invoice Please send an invoice to me at the above address for the amount of the registrations specified

Enter code (if we have given you one):

By registering, I agree to:

  • my/our details being held on a database for the purposes of conference administration and other activities associated with SIHI
  • my/our name, job affiliation and organisation being included on my/our conference name badge(s) and on a list made available to delegates

It is SIHI policy not to provide mailing lists to third parties. We occasionally send out items that we believe will be of interest to people on our contact list.

Cancellation and substitution. Cancellations notified more than 14 days before the conference will be eligible for a full refund. Otherwise, up to 48 hours before the conference, a cancellation fee of £10 per person will be charged. Cancellations at less than 48 hours notice will incur the full fee. Cancellations must be in writing or by email. Substitutions may be made at any time.

Confirm this registration by email.

In case of problems with this form, please email sihi@port.ac.uk

Supported by:

  SEHTA  

Last updated