KIPLING IN AMERICA REGISTRATION FORM

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Do not press Return until you are ready to send the form.


Please enter your surname:
first name:
title (Mr/Mme/etc..):
degrees/professional qualifications:
email address
address - line 1:
address - line 2:
address - line 3:
postcode/zipcode
country:
telephone number:
any special dietary or mobility needs ?
the conference fee is $15 plus options (for Vermonters), 40.00 (UK), or 50 (Europe)
or for the rest of the world $US60.00 (enter Yes or No)
the expected cost of the conference dinner is 25
(or 30, or $US40.00) (enter Yes or No)
to register please submit this form and post a cheque (//$) for conference and dinner (if required), to The Kipling Society, 6 Clifton Road, London W9 1SS. (please enter date cheque sent)
please enter date form submitted