Registration form for cheque payment

{"elements":[{"isDiscrete":false,"hidden":false,"name":"1260542083437_0.4991593034403625_0.2977230607040984","readOnly":false,"id":30657171,"type":"commentElement"},{"isDiscrete":false,"hidden":false,"name":"Full name","readOnly":false,"id":30657172,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Affiliation","readOnly":false,"id":30657173,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Year of study","readOnly":false,"id":30657174,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Research interests","readOnly":false,"id":30657175,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Email","readOnly":false,"id":30657176,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Address line 1","readOnly":false,"id":30657177,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Address line 2","readOnly":false,"id":30657178,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Town or City","readOnly":false,"id":30657179,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Postcode","readOnly":false,"id":30657180,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Country","readOnly":false,"id":30657181,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"1260366074621_0.15160824354568114_0.9844789098972486","readOnly":false,"id":30657182,"type":"commentElement"},{"isDiscrete":true,"hidden":false,"values":[{"text":"Yes.|Yes.|Yes.","value":"0-yes.yes.yes."},{"text":"No.|No.|No.","value":"1-no.no.no."}],"name":"Do you want to chair a session","readOnly":false,"id":30657183,"type":"radioElement"},{"isDiscrete":true,"hidden":false,"values":[{"text":"Talk|Talk|Talk","value":"0-talktalktalk"},{"text":"Poster|Poster|Poster","value":"1-posterposterposter"},{"text":"Talk and Poster|Talk and Poster|Talk and Poster","value":"2-talkandpostertalkandpostertalkandposter"},{"text":"None|None|None","value":"3-nonenonenone"}],"name":"Will you be giving a talk/poster","readOnly":false,"id":30657184,"type":"listElement"},{"isDiscrete":false,"hidden":false,"name":"1260366074622_0.8126754170260457_0.27944542390008087","readOnly":false,"id":30657185,"type":"commentElement"},{"isDiscrete":true,"hidden":false,"values":[{"text":"Yes.|Yes.|Yes.","value":"0-yes.yes.yes."},{"text":"No.|No.|No.","value":"1-no.no.no."}],"name":"Will you be attending the Pub Quiz","readOnly":false,"id":30657186,"type":"radioElement"},{"isDiscrete":true,"hidden":false,"values":[{"text":"Yes.|Yes.|Yes.","value":"0-yes.yes.yes."},{"text":"No.|No.|No.","value":"1-no.no.no."}],"name":"Will you be attending the Conference Dinner","readOnly":false,"id":30657187,"type":"radioElement"},{"isDiscrete":true,"hidden":false,"values":[{"text":"Pub|Pub|Pub","value":"0-pubpubpub"},{"text":"Cinema|Cinema|Cinema","value":"1-cinemacinemacinema"},{"text":"Bowling|Bowling|Bowling","value":"2-bowlingbowlingbowling"},{"text":"None|None|None","value":"3-nonenonenone"}],"name":"Tuesday entertainment","readOnly":false,"id":30657188,"type":"listElement"},{"isDiscrete":false,"hidden":false,"name":"Dietary","readOnly":false,"id":30657189,"type":"textBoxElement"},{"isDiscrete":false,"hidden":false,"name":"1260366074623_0.10551691041421896_0.9535526730871355","readOnly":false,"id":30657190,"type":"commentElement"},{"isDiscrete":true,"hidden":false,"values":[{"text":"Yes|Yes|Yes","value":"0-yesyesyes"},{"text":"No|No|No","value":"1-nonono"}],"name":"Do you require accommodation","readOnly":false,"id":30657191,"type":"radioElement"},{"isDiscrete":false,"hidden":false,"name":"1260366074623_0.994531127682197_0.7973076380719645","readOnly":false,"id":30657192,"type":"commentElement"}]}

Please note: This form is only for people wishing to register for RSC 2010 and pay registration fee via cheque If you wish to pay via secure online payment, please visit this page: http://www2.warwick.ac.uk/fac/sci/statistics/postgrad/rsc/2010/conference/registration/online

Full name

Affiliation

Year of study

Research interests

Address line 1

Address line 2

Town or City

Postcode

Country

Choose the appropriate options below.

Yes.|Yes.|Yes.

No.|No.|No.

Will you be giving a talk/poster

Entertainment

Yes.|Yes.|Yes.

No.|No.|No.

Yes.|Yes.|Yes.

No.|No.|No.

Tuesday entertainment

Do you have any special dietary requirements?|Do you have any special dietary requirements?

Accommodation

Yes|Yes|Yes

No|No|No

Instructions for Cheque Payment Please make a cheque payable to "University of Warwick" for the following amounts £210 - For registration with accommodation £115 - For registration without accommodation Please also print your full name and institution on the back of the cheque. All cheques should be posted to Jen Rogers Department of Statistics University of Warwick Coventry West Midlands CV4 7AL Once your cheque has been received, an email confirmation will be sent, though please be aware this may not be immediate due to Christmas Post.

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.

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