To make a credit card booking, print this page, complete the form, and
either fax or post it to us.
| Fax:: | +353 (1) 708 3848 | Postal
Address:: |
12th AICS,
c/o Diarmuid O'Donoghue, Department of Computer Science, NUI Maynooth, Co. Kildare, Ireland |
| Name: |
|
| Affiliation: | |
| Address: |
|
| Telephone: | |
| Fax: | |
| Email: | |
| Credit card type: | Visa / MasterCard (only) |
| Credit card number: |
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ |
| Name as it appears on credit card: |
|
| Expiry date: |
_ _ / _ _ |
| Please debit my credit card: | £120 (early) / £150 (late) (Ring one) |
| Signature of card-holder: |
|