Registration Form

Before completing this form please read conference booking details
Full name: (Mr/Mrs/Ms):
Name to appear on badge:
Job Title:
Company:
Address:
 
Postal code or zip code:
Country:
Telephone:
Fax:
E-mail:
Will you be attending the evening networking event on the 26th of May 2010?
 Yes No
Please indicate if you have any special dietary requirements
 Vegetarian Vegan Nut allergy
Please supply the name of your Accounts
Department Contact (Full name):
Accounts Department
telephone number:
Invoice address:
Company VAT or Tax number:
Purchase order number (if required):

Payment method - Please tick one of the three options below: Please note that to qualify for the earlybird discount payment must received by the 26th of February 2010. Special earlybird fee is €1063 per delegate + 19% Netherlands VAT. Standard delegate fee is €1250 per person + 19% Netherlands VAT. (A VAT invoice receipt will be issued at the time of the conference)

By invoice - Please send me an invoice
By cheque- Please make payable to Canadean Limited
By credit card (American Express/Mastercard/Visa) NB: Credit card transactions will be processed in £ sterling.
If by credit card, as this is not a secure site, please call the number below with the following credit card details: Cardholder name and initials, Card number, Expiry date, Cardholder's billing address (if different from address above), Card security code, and Name of bank issuing card. PLEASE CALL +44 (0)1256 394236 (during UK office hours).
I understand that this form is confirmation of my booking and agree to abide by the booking conditions set out in the conference booking details
Please tell us where you heard about this
conference:
Please indicate the nature of your business: