Iran Heritage Foundation

IRAN HERITAGE FOUNDATION

PRIVATE LIVES AND PUBLIC SPACES IN MODERN IRAN

Conference - Registration (Printer Friendly Form)

I wish to register for the conference
_____ Full registration	80 GBP on or before 1 July, 100 GBP after 1 July
_____ Students	40 GBP on or before 1 July, 50 GBP after 1 July
(concessionary status subject to presentation of proof; payments without proof of concessionary status will be returned)

Method of payment
_____ Cheque (payable to IRAN HERITAGE FOUNDATION)
_____ Credit card
Please debit my credit card (VISA, Mastercard & AMEX only)
_____ VISA _____ Mastercard _____ AMEX
Cardnumber	____________________________________
Expiry date	____________________________________
Name on card	____________________________________
Signature	____________________________________
Please fill in your name and address in block capitals
Name	____________________________________
Address	____________________________________
City	____________________________________
Postcode	____________________________________
Country	____________________________________
Tel	____________________________________
Fax	____________________________________
E-mail	____________________________________

Please print out this form and mail it with UK cheque, banker's draft in UK sterling or credit card details to: Private Lives Conference, Iran Heritage Foundation, 5 Stanhope Gate, London W1K 1AH. If paying by credit card you can also fax your registration to 44 20 74999293.