Portugal, the Persian Gulf and Safavid Persia

(Postal Registration Form)

This form allows you to register for the 'Portugal, the Persian Gulf and Safavid Persia' conference (Washington DC, Freer Sackler Galleries, Smithsonian Institution, 8-9 September 2007). Registration fee includes admission to:
- Reception on 7 September
- All conference sessions

It is only possible to register for the entire conference. There are no single day registrations.

Please note that the registration fee does not include any catering on conference days.

Only full time enrolled students qualify for the concessionary student registration rate. Proof of full-time student status must be faxed to 44 20 74999293 in order for student registrations to be accepted.

All offers below are subject to availability.

All sales final, payments are non-refundable.

All fields with * must be completed!

Registration

A separate registration form must be completed for each person.

__________

@ 30 British Pounds (approx. 60 US Dollars) - full rate

__________

__________

@ 15 British Pounds (approx. 30 US Dollars) - student rate for full-time students with proof of status

__________

TOTAL

__________

Method of Payment

Payment by cheque is possible, if drawn on a UK bank in Pound Sterling. Cheques should be issued in favour of the 'Iran Heritage Foundation'

Payment (Visa, Mastercard & Amex only)

_____ VISA  _____ Mastercard  _____ Amex

Card Number

________________________________________

Expiry Date

________________________________________

Security Code

________________________________________

Name on card

________________________________________

Personal Details

Title

________________________________________

First Name *

________________________________________

Middle Name

________________________________________

Last Name *

________________________________________

Department

________________________________________

Institution / Business

________________________________________

Address 1 *

________________________________________

Address 2

________________________________________

Address 3

________________________________________

City *

________________________________________

County/State

________________________________________

Post/Zip code *

________________________________________

Country *

________________________________________

Telephone

________________________________________

Mobile

________________________________________

Fax

________________________________________

E-mail *

________________________________________

I agree to the above terms and conditions:

Signature

________________________________________

Mail completed form to:
Portugal Conference, Iran Heritage Foundation, 5 Stanhope Gate, London W1K 1AH, United Kingdom.