The University of the West Indies at Mona, Jamaica

Application Form for Mona Symposium 2010

To attend the Mona Symposium, on 4th to 7th January, 2010, please fill in the details below and then select the Continue button at the end of the page to preview your information.

Registration Information:

First Name:

Last Name:

Mailing Address :

Email:

Mailing Address:
(continued)

Telephone No:

City:

Fax Number:

State/Province:

Zip Code :

Country:

Please provide the names of those who will be accompanying you (place commas (,) between names):

Registration Fee

Full Participants ($US450.00) Ass. Participants ($US250.00) Students ($US275.00)

Calculate Total

Total Payable

The registration fees cover all conference expenses including: conference dinner, day trip and shuttle service from off campus hotels to the University. The registration does NOT cover accommodation.

The Title of my	oral presentation (20 minutes) poster presentation	is

Accomodation Information:

Accomodation:

For conference rates please book hotels through the Organizing Secretary

Please select first and second choices of Hotels. The hotels are arranged by price, least expensive at the top.
Please note that hotel room attract Government taxes of 8.25% and a service charge of 10%

Shirley Retreat House	jeshirl@cwjamaica.com
The Jamaica Pegasus	mpegasus@cwjamaica.com

First Choice

Second Choice

Dates required for Hotel, please specify:

From:

TO:

Number of Rooms needed:

Special notes on Rooms request(eg. double or single
occupancy)

Flight Information:

Arrival in Jamaica

Departure From Jamaica

Arrival Date:

Departure Date:

Airline:

Flight Number:

Arrival Time

Departure Time

Special notes on Arrival

Special Notes on Departure

You may use your credit card to pay online after submitting your registration.

Please contact the Organizing Secretary for further registration information and help, preferably via email
(paul.reese@uwimona.edu.jm)