To: Les Mather, 8 Carnoustie Avenue, Chesterfield, Derbyshire, S40 3NN.

Tel:

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I enclose a cheque payable to North East Derbyshire Industrial Archaeology Society for £ ................ (£17.50 per head)

Please enclose a stamped self-addressed envelope for map, directions and receipt.

Please indicate here if you have any special dietary requirements:

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I wish to present a report on behalf of:

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I wish the following item to be included within the agenda for the reports meeting:

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I wish to have display space for:

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Anyone wishing to display material for sale other than on behalf of an EMIAC affiliated society or participating organisation will be expected to make a contribution to conference expenses.