Registration form (payment online)

{"elements":[{"isDiscrete":false,"hidden":false,"name":"Title","readOnly":false,"id":489978278,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Surname","readOnly":false,"id":489978279,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"First name","readOnly":false,"id":489978280,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Institution/organisation","readOnly":false,"id":489978281,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Department","readOnly":false,"id":489978282,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Post/position/course","readOnly":false,"id":489978283,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Address","readOnly":false,"id":489978284,"type":"textBoxElement"},{"isDiscrete":false,"hidden":false,"name":"Telephone","readOnly":false,"id":489978285,"type":"phoneNumber"},{"isDiscrete":false,"hidden":false,"name":"email","readOnly":false,"id":489978286,"type":"emailElement"},{"isDiscrete":true,"hidden":false,"values":[{"text":"Yes","value":"0-yes"},{"text":"No","value":"1-no"}],"name":"I have had an abstract accepted by the conference:","readOnly":false,"id":489978287,"type":"radioElement"},{"isDiscrete":false,"hidden":false,"name":"Dietary requirements","readOnly":false,"id":489978288,"type":"textBoxElement"},{"isDiscrete":false,"hidden":false,"name":"Disability requirements","readOnly":false,"id":489978289,"type":"textBoxElement"},{"isDiscrete":true,"hidden":false,"values":[{"text":"----","value":"----"},{"text":"Student: Mon 19 March only, no conference dinner - £68","value":"68"},{"text":"Student: Mon 19 March only, with conference dinner - £88","value":"88"},{"text":"Student: Tue 20 March only, no conference dinner - £68","value":"68"},{"text":"Student: Tue 20 March only, with conference dinner (on Mon 19 March) - £88","value":"88"},{"text":"Student: both days, no conference dinner - £80","value":"80"},{"text":"Student: both days, with conference dinner - £100","value":"100"},{"text":"Staff: Mon 19 March only, no conference dinner - £102","value":"102"},{"text":"Staff: Mon 19 March only, with conference dinner - £122","value":"122"},{"text":"Staff: Tue 20 March only, no conference dinner - £102","value":"102"},{"text":"Staff: Tue 20 March only, with conference dinner (on Mon 19 March) - £122","value":"122"},{"text":"Staff: both days, no conference dinner - £120","value":"120"},{"text":"Staff: both days, with conference dinner - £140","value":"140"}],"name":"Fees","readOnly":false,"id":489978290,"type":"paymentElement"},{"isDiscrete":true,"hidden":false,"values":[{"text":"I agree to my name, affiliation and email address being included on the attendance list distributed to all delegates at this event.","value":"0-iagreetomynameaffiliationandemailaddressbeingincludedontheattendancelistdistributedtoalldelegatesatthisevent."},{"text":"I would like to receive information about future IATL events.","value":"1-iwouldliketoreceiveinformationaboutfutureiatlevents."}],"name":"Agreements","readOnly":false,"id":489978291,"type":"checkboxElement"},{"isDiscrete":false,"hidden":false,"name":"1552134535526_0.5114264922238929_0.7119132870723374","readOnly":false,"id":489978292,"type":"commentElement"}]}

Title

Surname

First name

Institution/organisation

Department

Post/position/course

Address

Telephone

E-mail

Yes

Please outline any special dietary requirements:

Please indicate any access / disability requirements:

Please select the fee which applies to you (if you need to pay for your conference dinner separately, please select one of the ‘no conference dinner’ options below and complete your registration, then follow the link from the main BCUR 2012 page):

I agree to my name, affiliation and email address being included on the attendance list distributed to all delegates at this event.

I would like to receive information about future IATL events.

Please note that this event may be recorded in a variety of ways (e.g. video, still images, audio), with the resulting media subsequently used in such ways as the Institute for Advanced Teaching and Learning sees fit. If you would prefer not to be recorded, please make yourself known to the organisers on the day.

Privacy notice

This form will be used to manage your attendance at the British Conference of Undergraduate Research 2012. Your attendance at the event will be recorded and associated with your name, but no other personally identifiable data will be stored and your data will not be used for any purpose other than as a record of the event, unless you have given your permission above.

The University of Warwick is the Data Controller of any information you have entered on this form and is committed to protecting the rights of individuals in line with Data Protection Legislation. The University's Data Protection webpages provide further information on your rights and how the University processes personal data. If you wish to submit a data subjects rights request, make a complaint or report a suspected personal data breach, please contact the University’s Data Protection Officer by email at infocompliance@warwick.ac.uk.

Spam prevention

Refund policy: a full refund will be given for cancellations made on or before Friday 2/3/2012.

Institute for Advanced Teaching and Learning (IATL)

Registration form (payment online)

Failure to load reCAPTCHA