Application Form

I wish to attend the 4^thth Backpacker Research Group Meeting,
Hermanus, Western Cape, South Africa
2^nd-4^th September 2010

	Mr. Mrs.
Name
Institution
Department
Address
City, Postal Code
Country
Tel
Fax
E-mail Address

Special requests

	I enclose a paper abstract
	Vegetarian meals requested
	I'm interested in chairing one of the workshops

Meeting fee

Registration fees - prices in Euro's	ATLAS member	Non ATLAS member
Full package	€ 250	€ 350
Students	€ 150	€ 150

I am a member of ATLAS

Cancellation policy

If written cancellation is received before 31^stMay 2010, a refund of all meeting fees will be made, minus an administration fee of € 25. No refund will be possible after 31^st May 2010, but substitute delegates can be nominated.

Form of payment

As soon as you have been registrated an invoice/receipt will be send.

	I wish to pay by bank transfer
	I wish to pay by credit card (Euro Card Master Card, Visa Card, American Express Card). Please contact the ATLAS secretariat at: admin@atlas-euro.org

Biosketch / CV

For the creation of a detailed delegate list, please fill in this textbox with a small biosketch / CV of not more then 35 words.