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11 December 2010 Conference Booking Form

Conference on Apostasy, Sharia Law and Human Rights
Booking form
Saturday 11 December 2010, 10.00-19.00 hours
Conway Hall, 25 Red Lion Square, London

Please complete this form in block letters and post back or email to the address below along with payment before conference. If you are sending a cheque after 1 December, please also email the form to us so that we can add you to our list of participants.

Name of delegate ____________________________________________

Type of delegate (please tick)
0 Individual 0 Statutory organisation/Voluntary organisation

Organisation name (if applicable) ________________________________

Contact details
Address: ___________________________________________________

Tel: _________________ Email: ____________________________

Form of Payment (please tick)
0 £25 voluntary sector/statutory organisation; 0 £10 individuals. Donations are welcome.

0 Cheque (£ Sterling only) made payable to CEMB or One Law for All for amount of £_____.
0 Paypal payable on One Law for All website at: http://www.onelawforall.org.uk/donate/ for amount of £_____.
0 Worldpay payable on CEMB website at: http://www.ex-muslim.org.uk/indexDonate.html for amount of £_____.

0 Limited space is available for organisations to display their materials. If interested, please tick here and someone will get back to you.

Please note: Only cancellations received up to twenty working days before the conference are refundable. There may be an additional charge for those registering on the day of the conference.

Please return this form via post to BM Box 1919, London WC1N 3XX, UK or email it to exmuslimcouncil@gmail.com or onelawforall@gmail.com.
For more information, visit www.ex-muslim.org.uk or www.onelawforall.org.uk.

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