Conference Booking Form 25 th -28 th June 2013 Robert Gordon University, Aberdeen Section 1: Personal Details Section 2: Registration Details (please tick as appropriate) Full conference (including all conference sessions, lunches and refreshments, early evening reception and conference dinner) Early bird rate - £360 (available for booking and payments confirmed before 1 st April 2013) Full delegate rate - £410 (for bookings after 1 st April 2013) Research student rate - £290 (Please send proof of Student Status) Accompanying person Conference Dinner - £65 Day attendance (including all conference sessions, lunch and refreshments, early evening reception for those attending 25 th or 26 th June; does not include conference dinner): Tuesday 25 th June - £110 Wednesday 26 th June - £135 Thursday 27 th June - £110 Friday 28 th June - £110 Optional visits Saturday 29 th June: Balmoral Castle / Royal Lochnagar Distillery - £79 (Lunch at Balmoral Castle not included) Total payment due: ______________ Title: _______________Job Title: __________________________________ First Name: ______________________Organisation: __________________________________ Last Name: ______________________Address: __________________________________ __________________________________ Telephone: _________________________________________________________ _______________________ Postcode:__________________________________ Special Dietary/ Other Requirements : ______________________________________________ _______________________________________________

Section 3: Payment Options Please choose one of the following (tick and complete as appropriate) : Cheque (please make payable to The Robert Gordon University) Please note only cheques in GBP and drawn on a UK Bank account can be accepted. No other cheque format will be accepted. Sterling Travellers cheques are acceptable. Credit Card Name of cardholder :____________________________________________________ Address of cardholder:____________________________________________________ ____________________________________________________ Postcode: ___________________ Card type (Visa etc): __________ Card No: ______________________________________ Start date: ___ / ___Expiry date: ___ / ___ Issue No. (debit cards only): _____ Last 3 digits on security strip (reverse of card): _______ Please debit £ ____________ from the card above. Bank transfer - see details below. Delegates should quote "Delegate name & IM i3 Conference" Account Name – The Robert Gordon University Bank name – Bank of Scotland Bank Address – Queens Cross Branch, 39 Albyn Place, Aberdeen AB10 1YN, UK Sort Code – Account Number – IBAN – GB08 BOFS SWIFT/BIC – BOFSGB21353 Confirmation of all bank transfer payments should be sent to to help identification of payee. Please note the bookings cannot be fully confirmed until payment has been received (see Terms and Conditions). All payments must be received by 12 th June I confirm that I have read and understood the Terms and Conditions (available on the i 3 Website) Please return form to: Information: Interactions and Impact (i 3 ), H302, Faculty of Health and Social Care, Robert Gordon University, Garthdee Road, Aberdeen, AB10 7QG, UK.