CASI 2005 25th Conference on Applied Statistics in Ireland 18-20 May 2005

Registration Form
Please complete the following form and post or fax to:
POST:	Dr Adele Marshall (CASI 2005) David Bates Building Queen's University Belfast University Road Belfast, BT7 1NN Northern Ireland, UK	FAX:	+44 (0)28 9023 9182

Personal Details
Title:	Prof. Dr. Mr. Mrs. Miss. Ms.
First Name:		Last Name:
Affiliation:
Contact Street Address:
Town/City:		County/State:
Zip/Post Code:		Country:
Telephone No.:		Fax No.:
Email Address:
Are you a member of ISA?:		Yes:	No:
Are you a postgraduate student?:		Yes:	No:
If yes, please either forward a letter of confirmation from your supervisor, or else have your supervisor email a.h.marshall@qub.ac.uk

Conference Registration Details
Do you intend to present a paper?:		Yes:	No:
If applicable:

Title:

	Has your abstract been emailed to a.h.marshall@qub.ac.uk?:		Yes:	No:
	Is your abstract enclosed?:		Yes:	No:
	Please tick if you wish only to be considered for a poster presentation:		Poster Only:

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Please tick when you will be attending the conference:
Wednesday 18 May 2005	Day	Night
Thursday 19 May 2005	Day	Night
Friday 20 May 2005	Day

Will you be sharing a room with another delegate?		Yes:	No:	N/A:
If yes, please give name/s:
		Note: Rooms are available to accommodate 2 and 3 students sharing. Family rooms are also available.

Registration Costs

Costs for early registration (by 15th April 2005) are shown below.   Registrations received after 15 April 2005 will incur a late booking fee of € 50 / £ 35.   Please indicate the package appropriate to you:

	Full Conference Package (2 nights B&B, 2 evening meals, 3 lunches)		One-day Accommodation Package (1 night B&B, 1 evening meal, 1 lunch)
	Cost (€)	Cost (£)	Cost (€)	Cost (£)
Single (non-sharing)	€ 445	£ 310	€ 215	£ 150
Two Delegates sharing	€ 415 pp	£ 290 pp	€ 200 pp	£ 140 pp
One Delegate, One non-delegate sharing	€ 405 pp	£ 280 pp	€ 190 pp	£ 135 pp
Student (sharing)*	€ 360 pp	£ 245 pp	€ 170 pp	£ 120 pp

* Please remember to specify any preferences for who you share with
 

Daily Delegate Rate (Coffees, lunch each day, no accommodation)	Cost (€)	Cost (£)	Quantity
One day	€ 100	£ 70
Evening Meal	€ 35	£ 25

Optional Cruise of Lough Erne, "Lady of the Lake Cruise":	Cost € 7	Cost £ 5

To include late booking fee:	Cost € 50	Cost £ 35

Please note that the registration fee includes the ISA annual subscription of € 15
 
TOTAL AMOUNT PAYABLE     Euros Pounds

Payment
Payment Method:	Bank Transfer	Credit Card	Sterling Cheque/Bank Draft
Payment Enclosed:	Yes	No

For bank transfers please quote "CASI 2005" and transfer funds into the following account (please ensure that ALL transfer costs are met by you):

BANK: Ulster Bank ADDRESS: 91/93 University Road, Belfast, BT7 1NG, Northern Ireland, UK SORT CODE: 980155   ACCOUNT CODE: 30090092   ACCOUNT NAME: Queen's University General Account

ALL CHEQUES/BANK DRAFTS to be made payable to: "Q.U.B." (in pounds sterling), crossed and posted to the address at the top of this form.

Credit Card Type:	Visa	Mastercard
Credit Card Number:			Expiry Date:
Cardholder's Name: (As it appears on the credit card)
Total Charges (GBP):

Signature:				Date:
End of registration form Please now print this form and post or fax as outlined above