Multiple
delegate registration

Booking and Invoicing details:

Name of the person responsible for these registrations *

Telephone number of the person responsible for these registrations:

Country code *

Local code and telephone number *

Email address of the person responsible for these registrations*

(we will send a confirmation of the booking and a copy of the invoice by email to this address)

Please supply the name and address details that you wish to appear at the head of the invoice:

Organisation *

For the attention of:

Address line 1 *

Address line 2 (if required)

Address line 3 (if required)

City and postcode *

Country *

Please state any reference or purchase order number that you wish us to quote on your invoice:

Please use this box to supply any further instructions or information relevant to your booking or invoice:

Please note that everyone registered on this form will be included on a single invoice. If you need a separate invoice for each delegate you must use the single delegate registration form >>

Delegate details (please complete accurately):

I accept that the European Social Network will retain the delegates' contact details in their database in order to send them information concerning the European Social Services Conference or other information concerning European social services. Following the conference, ESN will remove any details from its database on request. ESN WILL NOT SHARE THIS DATA WITH ANY THIRD PARTY. *

How many delegates are you registering on this form? *

Name of delegates' organisation *
(as you wish it to appear on the official delegate list)

If different from the address already provided above for your invoice, please supply a postal address for the delegates' organisation/place of work:

Address line 1

Address line 2 (if required)

Address line 3 (if required)

City and postcode

Country

Delegate 1

Prof/Dr/Mr/Mrs/Ms etc

First Name *

Family Name *

Job title/position in organisation *
(as it will appear on the official delegate list)

Department (if not already stated above)

Please indicate here if this delegate is eligible for a conference discount.

(click here to see discount details)

-- ESN member organisation 20% EU new/candidate country public employee 10% Both of the above 20%+10%

If you have claimed the ESN member discount, please name the ESN member organisation to which this delegate is affiliated
(click here to see full ESN member list)

Individual email address *

This email address will be required for the delegate to gain access to our online workshop booking facility and should be unique for each delegate - please keep a record of the address entered and check it is correct!

Telephone country code

Local code and office number*

Delegate's preferred language*

Special needs/restricted diet (please supply full details).
If none, write 'none' *

Delegate 2

Prof/Dr/Mr/Mrs/Ms etc

First Name *

Family Name *

Job title/position in organisation *
(as it will appear on the official delegate list)

Department (if not already stated above)

Please indicate here if this delegate is eligible for a conference discount.

(click here to see discount details)

-- ESN member organisation 20% EU new/candidate country public employee 10% Both of the above 20%+10%

If you have claimed the ESN member discount, please name the ESN member organisation to which this delegate is affiliated
(click here to see full ESN member list)

Individual email address *

This email address will be required for the delegate to gain access to our online workshop booking facility and should be unique for each delegate - please keep a record of the address entered and check it is correct!

Telephone country code

Local code and office number*

Delegate's preferred language*

Special needs/restricted diet (please supply full details).
If none, write 'none' *

Delegate 3

Prof/Dr/Mr/Mrs/Ms etc

First Name

Family Name

Job title/position in organisation
(as it will appear on the official delegate list)

Department (if not already stated above)

Please indicate here if this delegate is eligible for a conference discount.

(click here to see discount details)

-- ESN member organisation 20% EU new/candidate country public employee 10% Both of the above 20%+10%

If you have claimed the ESN member discount, please name the ESN member organisation to which this delegate is affiliated
(click here to see full ESN member list)

Individual email address

This email address will be required for the delegate to gain access to our online workshop booking facility and should be unique for each delegate - please keep a record of the address entered and check it is correct!

Telephone country code

Local code and office number

Delegate's preferred language

Special needs/restricted diet (please supply full details).
If none, write 'none'

Delegate 4

Prof/Dr/Mr/Mrs/Ms etc

First Name

Family Name

Job title/position in organisation
(as it will appear on the official delegate list)

Department (if not already stated above)

Please indicate here if this delegate is eligible for a conference discount.

(click here to see discount details)

-- ESN member organisation 20% EU new/candidate country public employee 10% Both of the above 20%+10%

If you have claimed the ESN member discount, please name the ESN member organisation to which this delegate is affiliated
(click here to see full ESN member list)

Individual email address

This email address will be required for the delegate to gain access to our online workshop booking facility and should be unique for each delegate - please keep a record of the address entered and check it is correct!

Telephone country code:

Local code and office number

Delegate's preferred language

Special needs/restricted diet (please supply full details).
If none, write 'none'.

Delegate 5

Prof/Dr/Mr/Mrs/Ms etc

First Name

Family Name

Job title/position in organisation
(as it will appear on the official delegate list)

Department (if not already stated above)

Please indicate here if this delegate is eligible for a conference discount.

(click here to see discount details)

-- ESN member organisation 20% EU new/candidate country public employee 10% Both of the above 20%+10%

If you have claimed the ESN member discount, please name the ESN member organisation to which this delegate is affiliated
(click here to see full ESN member list)

Individual email address

This email address will be required for the delegate to gain access to our online workshop booking facility and should be unique for each delegate - please keep a record of the address entered and check it is correct!

Telephone country code

Local code and office number

Delegate's preferred language

Special needs/restricted diet (please supply full details).
If none, write 'none'.

Delegate 6

Prof/Dr/Mr/Mrs/Ms etc

First Name

Family Name

Job title/position in organisation
(as it will appear on the official delegate list)

Department (if not already stated above)

Please indicate here if this delegate is eligible for a conference discount.

(click here to see discount details)

-- ESN member organisation 20% EU new/candidate country public employee 10% Both of the above 20%+10%

If you have claimed the ESN member discount, please name the ESN member organisation to which this delegate is affiliated
(click here to see full ESN member list)

Individual email address

This email address will be required for the delegate to gain access to our online workshop booking facility and should be unique for each delegate - please keep a record of the address entered and check it is correct!

Telephone country code

Local code and office number

Delegate's preferred language

Special needs/restricted diet (please supply full details).
If none, write 'none'.

Please wait for the automated confirmation page to appear on your screen after you press the submit button.

You may wish to copy the information it contains to your delegates. Thank you!

Any problems or changes to your booking: please email louisa.greenbaum@esn-eu.org