Booking Form

Constructed Wetlands – Water Management, Treatment and Reuse CWA Annual Conference 18th – 19th September 2012, London Wetlands Centre DELEGATE DETAILS: COMPANY NAME: Title: Name: Position: Address Phone: Email: ADDITIONAL DELEGATE: Title: Name: Position: Phone: Email: ADDITIONAL DELEGATE: Title: Name: Position: Phone: Email: CONFERENCE FEES: Inclusive 2-day Rates Rate Inc. VAT @ 20% Quantity Total Payable CWA Members £350 £420 Non-Members £425 £510 Students and Charities £200 £240 Conference Dinner (18/09) £50 £60 TOTAL £ METHOD OF PAYMENT Credit / Debit card: Card Number Name on card Registered address (if different to above) Expiry Date Security Number (Last 3 digits on reverse) Cheque: Payable to AE Technology Transfer (A receipt will be sent automatically). Invoice: Please invoice for the sum of £ ……………… Purchase order number …………………………. Accounts contact Name Address for Invoice/ receipt: Phone: Email: 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 or before the event whichever is sooner. Signature ………………………………………….. Date ………………… ENQUIRIES AND BOOKING FORMS DIRECTED TO: AE Technology Transfer, Unit 8, Appleton Court, Calder Park, Wakefield, WF2 7AR Email: clarehunter@aquaenviro.co.uk, Web: www.aquaenviro.co.uk