SCHOOL OF ORIENTAL AND AFRICAN STUDIES

UNIVERSITY OF LONDON

Jews and Judaism in Black Africa and its Diasporas

on 30-31 October 2010

at the School of Oriental and African Studies (SOAS)

*all students and concessions will be required to show evidence of proof of student/SOAS status when registering.
Payment may be made by credit card, cash or cheque.

Please return your completed form and fee to:
Centres and Programmes Office, SOAS, Thornhaugh Street, Russell Square, London, WC1H 0XG
Email: centres@soas.ac.uk ; Fax: +44 (0)2 7898 4489; Tel: +44 (0)20 7898 4893/2

YOUR CONTACT DETAILS (please use BLOCK CAPITALS)

Email address and/or postal address. This information is for our records only, and will not be divulged without your prior consent.

Title: (e.g. Professor, Dr, Mr, Ms, Miss, Mrs)
Forename(s):
Surname:
Email:
Or Mailing Address (if you don’t have access to email): Please note that it is our policy to send acknowledgement of your registration/payment by email. If you would like acknowledgement by post please enclose a stamped, self-addressed envelope.

CREDIT CARD PAYMENTS

Card type:
Visa / Mastercard / Eurocard / Switch (delete as appropriate)
(please note that we do not accept American Express)
Total Amount: £
Name and Initials – as stated on card:
Card number:
Issue Number – 16 to 19 Digits (for Switch cards only):
Valid from – mm / yy:
Expiry date – mm /yy:
CVC Number (last 3 digits on the back of the card):
Billing address:
Signature:
Date:

CHEQUES: Cheques need to be made payable to 'SOAS' and sent to: Jane Savory, Centres and Programmes Office, SOAS, Thornhaugh Street, Russell Square, London, WC1H 0XG

CASH: Cash payments should be made in person to Jane Savory or Rahima Begum in Room 479, Centres and Programmes Office, SOAS, Thornhaugh Street, Russell Square, London, WC1H 0XG

For office use only

Fee:	Amount Paid:	Method of Payment:
Receipt Required:	Y/N Receipt sent by:	Date:
Processed by:		Date:
Notes: