Please carefully complete the below details, as they will be used for your conference name badge. Please ensure your email address is correct as all correspondence will be by email. Any relevant discount will be applied later in the booking form. We will send a confirmation of your booking within 2 working days and invoice you at the invoice address you specify at the end of the form. If you have not heard from us, please call us on +44 (0) 20 7336 4600.
[*] Mandatory Fields
* Where did you hear about this event? — E-mail Web Search Brochure Mailing Insert Event website Magazine Word of Mouth Call from OsneyMedia
* Title — Mr Mrs Miss Ms Dr Professor * First Name * Last Name * Job Title * E-mail * Telephone
Select PRA Membership Package — Platinum Membership: £6,000 Gold Membership: £3,500 Silver Membership: £2,000 Bronze Membership: £1,000 Knowledge Partnership: £500
I'm a PRA member and I would like to use my PRA Member Training Days at £175 per day of attendance.
Select PRA Training Course
Title — Mr Mrs Miss Ms Dr Professor First Name Last Name Job Title E-mail Telephone
— Mr Mrs Miss Ms Dr Professor First Name Last Name Job Title E-mail Telephone
PDF/brochure received from (Contact)
Comment:
* Company name * Address Line 1 Address Line 2 * Town/City * County/State * Country * Postcode * Telephone Fax VAT number
£ GBP ‚¬ Euro $ US Dollars
Invoice Details (if different from company details) Name E-mail Company Address Line 1 Address Line 2 Town/City County/State Country Postcode
Booking authorised by: Name Job Title Your PO/Authorisation Number Accounts payable contact Accounts payable email
Note: Payment must be received on or prior to the first day of the event or 15 days from the invoice date whichever is the earlier.
Please call me for credit card details Please charge my credit card (tick as applicable): Visa MasterCard Switch AmEx All card payments will be subject to a Handling Fee of 4%. All card transactions are processed in GBP only. Invoice & receipt will follow by email.
Card No Expiry Date Security code (AmEx N/A) Issue Number (Switch only) Valid from (Switch only) Cardholder’s Name
Same as Company Address Same as Invoice Address My credit card is billed to a different address – details below:
Billing address (if different from company details or invoice address) Address Line 1 Address Line 2 Town/City County/State Country Postcode
OsneyMedia Bank details: NatWest Kingston upon Thames, Market Place Branch, 5 Market Place, Kingston upon Thames, Surrey KT1 1JX, UK
Account Name: OsneyMedia Limited GBP Account: 71285202 Sort Code: 60-60-02 Euro Account: 550/00/10293337 Sort Code: 60-60-02 US Dollar Account: 140/00/08444129 Sort Code: 60-60-02 Note: Cheques payable to OsneyMedia Limited
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