International Public Speaking Competition 2012 Monday 14 May 2012 – Friday 18 May 2012
Preliminary Registration Form Competition organisers, participants and/or accompanying guests should complete this form and submit it via e-mail to ipsc@esu.org by Friday 4 May 2012
Country Name Organiser / Participant / Accompanying Guest / Other (pleaseselect) E-mail Address Registration Fees
Description Participant Fee Accompanying Guest Fee(twin room) Accompanying Guest Fee(single room) Total Amount Due
Unit Cost £150 per person £300 per person £450 per person
Quantity
Total Cost
Payment Method 1: Credit / Debit Card Please Select (Y/N):
Card Type1 Card Number Start Date End Date Issue Number (Switch cards only)
Security Number (last three digits on the back of the card)
Cardholder Name (As it appears on your bank statement)
Cardholder Address (As it appears on your bank statement)
Payment Method 2: Electronic Funds Transfer (EFT) / Bank Transfer Please Select (Y/N): •
Please transfer the value of the total amount payable (above) to The EnglishSpeaking Union.
Bank Name Account Name Sort Code Account Number 1
Coutts & Co, 440 Strand, London WC2R0QS The English-Speaking Union of the Commonwealth 18-00-02 0181-7590
Mastercard, Visa, Switch or Maestro. We do not accept American Express.
BIC (Bank Identifier Code) COUT-GB22 IBAN (International Bank Account Number) GB50-COUT-1800-0201-8175-90 Payment Method 3: Cheque / Bank Draft Please Select (Y/N): •
Please enclose a cheque made payable to The English-Speaking Union for the value of the total amount due (above). Payment Method 4: Payment On Arrival Please Select (Y/N):
•
If you would like to pay your registration fee(s) (or part thereof) on arrival, please contact the IPSC Convenor before Friday 4 May 2012.