Booking Form

6th European Waste Water Conference & Exhibition 9th & 10th October 2012, Lancashire County Cricket Club, Manchester DELEGATE DETAILS COMPANY NAME: Title: Name: Position: Address: Phone: Email: ADDITIONAL DELEGATES Name: Email: Job Title: Phone Name: Email: Job Title: Phone Name: Email: Job Title: Phone DELEGATE FEES Both Days VAT@20% Fee inc. VAT No. TOTAL FULL DELEGATE £390 £78 £468.00 AUTHOR £290 £58 £348.00 STUDENT/ACADEMICS & CHARITIES £180 £36 £216.00 One Day: (please circle which day) 9th & 10th October 2012 ONE DAY DELEGATE £290 £58 £348.00 ONE DAY AUTHOR £190 £38 £228.00 ONE DAY STUDENTS, ACADEMICS & CHARITIES £100 £20 £120.00 CONFERENCE DINNER (Inc. tour of Man Utd FC) £60 £12 £72.00 TOTAL Group Discounts ? Book 3 delegates and get the 4th free (cheapest one will be free, must be booked at the same time) Signature …………………………………………………………………………………………………………………………….. Date ……………………………………. METHOD OF PAYMENT Cheque: Payable to AE Technology Transfer (A VAT Receipt will be sent automatically). Invoice: Please invoice for the sum of £……………… Purchase order number ……………………………………. Accounts Contact Name Address for Invoice/ receipt: Email: Phone: 6th European Waste Water Conference & Exhibition 9th & 10th October 2012, Lancashire County Cricket Club, Manchester Credit / Debit card: Card type e.g Visa Card Number Name on card Registered address (if different to above) Expiry Date Issue Number ( for Switch) Security Number (Last 3 digits on reverse TERMS AND CONDITIONS: A charge of £50 will be levied for cancellations made up to 20 days prior to the event. Cancellations after this period will be liable for payment of the full fee. Payments should be received 30 days from receipt of the invoice. PLEASE SEND ENQUIRIES AND BOOKING FORMS TO: Aqua Enviro Technology Transfer, 8 Appleton Court, Calder Park, Wakefield, WF2 7AR Email: clarehunter@aquaenviro.co.uk, Web: www.aquaenviro.co.uk