This form will enable you to reserve your place at the the South West Civic Society Conference 2005. It does not take any payments of any kind and is purely designed for reservation purposes only. Once we receive your form we will send you an invoice for the amount (delegate number multiplied by £17) and after your payment clears we will send you confirmation and directions etc. Please provide the following contact information: Name Title Organization Street Address Address (cont.) City State/Province Zip/Postal Code Country Work Phone Home Phone FAX E-mail URL What type of reservation would you like make? Confirmed (wish to pay now for guaranteed places) Provisional (reserved for you but not guaranteed) How many delegate places do you wish to book? 1 2 3 4 5 6 7 8 9 10 11+ Enter the 1st delegate name in the space provided. Enter the 2nd delegate name in the space provided. Enter the 3rd delegate name in the space provided. Enter the 4th delegate name in the space provided. Enter the 5th delegate name in the space provided. Enter the 6th delegate name in the space provided. Enter any other delegate names in the space provided. Please state here any special requirements you may need. By reserving your delegate place/s you must agree to the following terms: I understand that each delegate price is £17 including vat and if I have to cancel my reservation I understand that I must give at least 7 days notice to qualify for a full refund. Yes No Please help us by answering the following optional questions. Have you visited the Taunton Civic Society website before? Yes No How would you rate your opinion of the Taunton Civic Society website? 1 being low and 5 being high. 1 2 3 4 5 If you were offered an email newsletter by the Taunton & District Civic Society would you be interested? Yes No Have you attended a Civic Society conference before? Yes No If you could choose a subject for the next Civic Society conference what would it be? Do you find it easier to book your conference place online? Yes No If you prefer another method of booking your conference place what method would that be? Please select one. Via direct mail to your address to which you subscribe to Using a coupon/form from a leaflet or magazine Through your organization heads who purchase on your behalf Through an e-commerce site that you pay/book by credit card Data Protection - We promise that any information you give will be used for Taunton & District Civic Society purposes only. PLEASE NOTE: If you are making a 'Confirmed Booking' please print the page that appears after you click the 'Submit Form' button and send this with your payment Payments should be made by cheque and made payable to 'Taunton & District Civic Society'. Author: ADK Ltd Copyright © 2005 Taunton & District Civic Society. All rights reserved. Revised: 21/03/05 click here to return to the conference information page