Registration Form

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ICSM Spring Conference 2020: Mind Over Matter

Sir Alexander Fleming Building, Imperial College Road, London

15^th February 2020 (Saturday)

Register for the Conference

To ensure that confirmation of place is not delayed, could you kindly state if you are registering and paying for this course/event for yourself or on behalf of someone else?

I am registering and paying for myself

I am registering and paying on behalf of someone

Please provide YOUR DETAILS so that we can match the payment with the candidate's details in our system.

Forename

Surname

Address

Country

Pin code/Post code/ Zip code

Phone number (including country code if outside the UK)

Please state your relation to this candidate