KIPLING IN AMERICA LOCAL REGISTRATION FORM

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Please enter your surname:
first name:
title (Mr/Mme/etc..):
email address
address - line 1:
address - line 2:
address - line 3:
zipcode
telephone number:
any special dietary or mobility needs ?
the basic conference fee is $US15 for Vermonters (enter Yes or No) See below for further options
the cost of lunch in the Library on 7 Oct is $US12 (enter Yes or No)
the cost of the conference dinner is $US40 (enter Yes or No)
the cost of the lecture and visit to Naulakha on 8 Oct is $US10 (enter Yes or No)
the cost of a set of background documents delivered by email is $US10 (enter Yes or No)
to register please submit this form and post a cheque for conference, dinner, and other options (if required), to The Kipling Society, 6 Clifton Road, London W9 1SS. (please enter date cheque sent)
please enter date form submitted