Title*
	First Name
	Surname
	Institution/Employer
	Job Title
	Address*
	Postcode*
	Country
	E-mail*
	Telephone Number*
	Please tick the category that applies to you:
	Members of affiliate bodies (ASEE, the International Network for Engineering Studies, The Royal Academy of Engineering, the British Academy and the Society for Philosophy & Technology):
	Non Student (£125):     Student (£75):
	Non-members of affiliate bodies
	Non Student (£150):     Student (£100):

Payment:

Note: registration is not complete until payment is received.

Cheque: I will send a cheque or banker's draft to The Royal Academy of Engineering for the sum of: £

Credit card: I will pay credit card payments (Visa, Mastercard) the sum of £

Credit card payments can be made by phone or fax. If you would like to pay by phone, telephone Cuong Dang on (+44)20 7766 0649 with the following information:

• Your name and institution

• Name on card

• Card number

• Security code (last three digits of the number on signature panel on reverse of card)

• Card expiry date

If you would like to send your details by fax, fill in this form below and send it to (+44)20 7389 7520.

• Credit Card Form (252KB)

Postal Address: Cuong Dang, Workshop on Philosophy and Engineering
The Royal Academy of Engineering
3 Carlton House Terrace
London, SW1Y 5DG

If you have any questions about registration, email Cuong Dang or Dr Natasha McCarthy

Please click only ONCE and wait for the form to be submitted.