Dispensing Doctors' Association

Friday 31st October – Sunday 2nd November 2008

The Majestic Hotel, Harrogate

Delegate Registration Form

PLEASE READ THE TERMS AND CONDITIONS BELOW PRIOR TO FILLING OUT THIS FORM.

I have read and I accept the Terms and Conditions*

DELEGATE DETAILS:

Title:*		First Name:*		Surname:*

Address for correspondence:*

Is this your home or work address?*

If work, please include your company/institution and department name below:

Company/Institution:

Position:

Address*:

City/Town*:

State/Province/County:

Post/Zip Code*:

Country*:

Telephone*:

Int’l Code		Area Code:		Number:

Mobile:

Fax:

E-Mail*:

Further Information:

GP's HA Number:
GP Pres. Number:
DDA Roll Number:

Special Requests (e.g. Dietary)

ACCOMPANYING GUESTS (not participating in conference)

Title	First Name	Surname	Relationship

DELEGATE REGISTRATION OPTIONS: *

Options	Breakdown	Member	Non-Member
Option 1	Saturday & Sunday attendance inc lunches Friday & Saturday accommodation Friday & Saturday evening dinners Sunday lunch	£330.00	£400.00
Option 1 plus partner	Saturday & Sunday attendance for delegate Friday & Saturday dinners inc partner Accommodation supplement on Friday & Saturday nights Sunday lunch inc partner	£455.00	£555.00
Option 2	Saturday & Sunday attendance inc lunches Saturday accommodation Saturday evening dinner Sunday lunch	£205.00	£250.00
Option 2 plus partner	Saturday & Sunday attendance for delegate Accommodation supplement on Saturday Saturday evening dinner inc partner Sunday lunch inc partner	£290.00	£340.00
Option 3	Saturday & Sunday attendance inc lunches Saturday evening dinner No accommodation	£150.00	£170.00
Option 4	Saturday & Sunday attendance inc lunches No evening meals or accommodation included	£90.00	£110.00

ROOM TYPES AVAILABLE:

If you have selected an option which provides accommodation you will be booked into a double room at the Majestic Hotel.

We do have a limited number of twin and family rooms available. Please specify below if you require a specific room type otherwise we will allocate you a double room.

The twin and family rooms will be booked on a first-come first-served basis so please book early to avoid any disappointment.

No Room Required

Double Room

Twin Room

Family Room

ARRANGEMENTS FOR CHILDREN:

No of Children

Child name(s) and age(s)

Dietary requirements

Medical Conditions

Room Supplements for Friday	Sharing parents room (inc breakfast) Child up to 16 years	£25.00 per child per night
Room Supplements for Saturday	Sharing parents room (inc breakfast) Child up to 16 years	£25.00 per child per night
Themed buffet on Friday	Any child up to 16 years	£10.00 each
Uncle Bob Entertainment on Saturday	Includes: Children's Entertainer from 2pm High Tea from 4.30pm	FREE
Sunday Lunch	Any child aged 6 - to 16 years (Under 5’s free)	£12.00 each

IMPORTANT NOTICE
Due to health and safety regulations and insurance purposes children will not be permitted into the exhibition area, and children are the responsibility of their parents at all times.

Baby Sitting Service Children are not permitted to attend the Formal Conference Dinner on Saturday evening.

Please contact the Majestic Hotel directly on 01423 700300 to arrange baby sitting/listening services. Please note these must be paid for as instructed by the hotel.

EMERGENCY CONTACT DETAILS

Please note this must be a number we can contact you on throughout the conference, in particular the High Tea. Please notify us on site should this change.

	Name	Mobile	Relationship to child/children
1:
2:

COMPLIMENTARY TICKETS TO HARROGATE PUMP MUSEUM

Learn more about the history of the Spa town of Harrogate. If you would like tickets to the museum open 10.00am – 4.00pm Saturday and 12.00pm – 4.00pm Sunday please indicate the number of tickets you require:

Adult Tickets
Concession Tickets
Child Tickets

Additional Information:

Please use the box below to insert any additional comments that you feel may be useful in processing your requirements

(to clear the form and start again)