REMS booking form

Please fill in your name in capitals and write legibly to ensure that I can identify you correctly. There is no need to fill in other details unless they have changed or are unknown to me. Please indicate if your name or address on the envelope are incorrect. If you want me to use a different email address, please enter it below.

Title and Name

 

Address

 

Postcode

 

Email Address

 

Telephone no.

 

IOP Membership no.

 

 

Please enter your selection in the table below and use one of the payment methods listed on the first page of my letter. Please fill in the order of preference column (1 is highest and 9 is lowest), apart from the At Home and London Loop Walk cells, which already contain zero. There is room for everyone in the Rutherford Theatre and we haven’t had to restrict our walkers yet. I will either email you or write to you with the results and any visit specific information.

Date

Event

Cost Per Person

Order Of Preference

Number Of Places

Name Of Guest

Total Cost

14 January

At Home – A Miscellany

£25.00/
£5.00

0

 

 

 

21 January

NMWL and Kneller Hall

£15.00

 

 

 

 

17 February

National Physical Laboratory

£18.00

 

 

 

 

4 March

Lambeth Palace and National Theatre

£14.00

 

 

 

 

27 March

London Loop Walk 10

£2.00

0

 

 

 

31 March

City of Oxford Visit

£6.00

 

 

 

 

 

Less any credit from previous quarter notified to you

 

 

 

 

–£

 

Total amount to pay

 

 

 

 

 

 

 

If you have put your name down for the NWML & Kneller Hall visit, please enter C or T here to indicate whether you are coming by Car or Train.

 

Suggestions for visits and speakers for At Homes:                Willing to organise suggested visit(s) Yes/No

 

 

If you want a label, enter the name to be put on it here.     

Please mail or email the form to me so that I receive it by 30th November. You can check availability after that date by emailing me at reinalt@physics.org or telephoning me at 020 8946 3399. All cheques should be made payable to the IOP.

 

Reinalt Vaughan-Williams,
21 Coombe Gardens,
London SW20 0QU

Tel: 020 8946 3399