Iran Heritage Foundation

IRAN HERITAGE FOUNDATION

NIZAMI GANJAVI – ARTISTIC AND HUMANISTIC ASPECTS OF THE KHAMSA
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Conference | Registration

I wish to register for the conference

__ 40 GBP - Full registration
__ 30 GBP - Concession rate

(Concessions subject to presentation of proof. Payments without proof of concessionary status will be returned)

Registration fee is inclusive of lunch

Method of payment

__	Cheque (payable to IRAN HERITAGE FOUNDATION)
__	Credit card Please debit my credit card (AMEX, VISA and Mastercard only, please circle)

Cardnumber	____________________________
Expiry date	____________________________
Name on card	____________________________
Signature	____________________________

Please fill in your name and address in block capitals

Title	____________________________
Name	____________________________
Address	____________________________
City	____________________________
Postcode	____________________________
Country	____________________________
Daytime Phone	____________________________
Fax	____________________________
Email	____________________________

Please print and return this form, with UK cheque, banker’s draft in UK sterling or credit card details to: Nizami Conference, Iran Heritage Foundation, 5 Stanhope Gate, London W1K 1AH. If paying by credit card you can also fax your registration to 020 7499 9293.