Event

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Title

First Name

Last Name

Job title:

Department

Institution

Please write your institution name as you would have it appear on your delegate name badge.

Address line 1

Address line 2

Town or city

County

Postcode

Country

Work phone number

Special dietary requirements/allergies |Special dietary requirements/allergies

Would you like to be included on the History at the Higher Education Academy Mailing List?|Would you like to be included on the History at the Higher Education Academy Mailing List?

NB: Because we expect this to be a high-demand event, there will be a charge of £10 (to cover catering and materials) in the case of cancellations after DATE. No charge will be made for cancellations before that date. Any places which do become available will be offered to those who have previously registered an interest on a first come first served basis. By booking a place you agree to these terms.

Privacy notice

This form will be used to manage attendance at an event. Your attendance at the event will be recorded and associated with your name, but no other personally identifiable data will be stored, and the data will not be used for any purpose other than as a record of the event.

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