Registration
LAW, POLICY AND THE OLYMPIC MOVEMENT
CONFERENCE REGISTRATION
May 16-18, 2012
Ithaca College London Center
35 Harrington Gardens, London SW7 4JU
Surname:___________________________First Name:___________________
Position/Title:____________________________________________________
Affiliation:_______________________________________________________
Address:________________________________________________________
Zip Code and City:________________________________________________
Country:________________________________________________________
Telephone:_______________________E-mail:_________________________
_______________________________________________________________
Print Name (as it should appear on name tag)
Professional Student Total
Prior to March 15, 2011 £ 75.00 £ 40.00
Single Day prior to March 15, 2011 £ 25.00
After March 15, 2011 £ 90.00 £ 60.00
Single Day after March 15, 2011 £ 30.00
Extra Ticket for Olympic £ 10.00 £ 10.00
Facilities Tour
Extra Ticket for Welcome £ 10.00 £ 10.00
Reception
Amount Due
• Note: Your conference registration fee includes the Thursday evening
reception and the facility tour.
Payment Methods--credit cards, cheques, or money orders
Credit Card Type__________________Credit Card Number________________
Exp. Date____________________ Verification Code______________________
________________________________________________________________
Print Name as Shown on Card
________________________________________________________________
Authorized Signature Today's Date
Billing address if different from above:
Address:__________________________________________
Zip Code and City:__________________________________
Country:__________________________________________
Mail/Fax or E-mail completed registration form, along with check or money order to:
Bill Sheasgreen
Ithaca College London Centre
35 Harrington Gardens
London SW7 4JU
phone 011-44(0)207-244-4800
fax 011-44(0)207-244-4808
E-mail: wsheasgreen@ithaca.edu
Registration must be received by 15 March 2012 or late fees apply!