Paying by Credit Card

Payment by credit card will only be accepted by completing the information below and faxing directly to the Conference Organiser.

If you are applying for sponsorship, please do not send payment yet. If you do not require sponsorship and wish to pay by Credit or Debit card, fill in the following information below on the hardcopy and send by post or fax to CCP4. Card details you supply here will not be stored in any database used by CCLRC, nor, except for the purposes of payments for this event, disclosed to a third party.

If you are paying multiple registration fees, please enter below each registrants' name, institution and accompanying total.

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I wish to pay via Credit Card Debit Card
Card Name (Visa, Delta, Mastercard etc) ................................................................................

Card Number ...................................................................................................................................

Cardholder's name as it appears on card ...................................................................................

Expiry date ...............................................................................

Signature of Cardholder...............................................................................................................

Receipt for card payment to be sent to me at address: (if different from the address on registration form)

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Once filled out, this form should be either faxed (no cover note necessary) to: Maeri Howard Eales, 44 (0) 1925 603 825
Or sent to: Maeri Howard Eales, CCP4, Daresbury Laboratory, Warrington, Cheshire, UK. WA4 4AD