Booking Form - Eic Non Member
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1Opportunities in Canada
October 2013
BOOKING FORM – EIC Non Member
Name
Company Name
Job Title
Address
(in full with postcode)
Please note: This is the address
which your receipt will be sent to
Telephone with Code
Mobile Number
Email
Please reserve ____ place(s) at £75.00
= £90.00 p/p
Total £ ____________
(+ VAT @ 20%)
Additional Delegates Names: __________________________________________________________________
Any Dietary Requirements?:___________________________________________________________________
Any Access Requirement? :___________________________________________________________________
Please select which date you would like to attend:
Tuesday 22 October – EIC Conference Suite, London
Wednesday 23 October – The Hallmark Hotel, Manchester
Thursday 24 October – Copthorne hotel, Aberdeen
Please select a method of payment
Cheque made payable to “Energy Industries Council” and enclosed with this form
By Credit Card or Debit Card (please complete details below)
VISA
VISA DEBIT
VISA ELECTRON
MASTERCARD
AMEX
Card Number _____________________________________________________________________________
Start Date ________________ Expiry Date ________________ 3 Digit Security No.___________________
Name on Card _____________________________________________________________________________
Address Card Registered to: __________________________________________________________________
RETURN THIS FORM TO:
Postcode: _______________________________
The EIC, 89 Albert Embankment, London, SE1 7TP
E:
F: 020 7091 8601
Please retain a copy for your records
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