To register for the 8th EPLS Meeting, please complete this form and return to NGA using one of the following methods: Post NGA, Millennia House, Kingswood Park, Bonsor Drive, Kingswood, Surrey, KT20 6AY, UK Email Fax 00 44 (0)1737 379 802 Title Dr / Mr / Mrs / Ms Name Job Title Company Address Country Telephone Email (general contact and confirmation) Email (used for delegate contact system) Special Requirements (e.g. dietary, access requirements etc) VAT Number (must be completed to confirm registration) Price €765 Early Payment Discount for payments received by 20th May 2016 Rate €915 Standard Rate for payments received on or after 21st May 2016 Accommodation Payment Payment by Cheque made payable to ‘NGA’ at the address above Payment by Bank Transfer details will be sent out with booking confirmation Payment by Credit Card MasterCard or Visa only, complete section below Name of Card Holder Credit Card Number Expiry Date Security Code Cardholder Signature Date The online delegate contact system will be opened at the beginning of June, at which time you will be emailed a password to allow you access to the delegate contact system on the PLG Europe website, Booking Terms & Conditions
To register for the 8th EPLS Meeting, please complete this form and return to NGA using one of the following methods: Post NGA, Millennia House, Kingswood Park, Bonsor Drive, Kingswood, Surrey, KT20 6AY, UK Email Fax 00 44 (0)1737 379 802 Title Dr / Mr / Mrs / Ms Name Job Title Company Address Country Telephone Email (general contact and confirmation) Email (used for delegate contact system) Special Requirements (e.g. dietary, access requirements etc) VAT Number (must be completed to confirm registration) Price €765 Early Payment Discount Rate for payments received by 20th May 2016 €915 Standard Rate for payments received on or after 21st May 2016 Accommodation Payment Payment by Cheque made payable to ‘NGA’ at the address above Payment by Bank Transfer details will be sent out with booking confirmation Payment by Credit Card MasterCard or Visa only, complete section below Name of Card Holder Credit Card Number Expiry Date Security Code Cardholder Signature Date The online delegate contact system will be opened at the beginning of June, at which time you will be emailed a password to allow you access to the delegate contact system on the PLG Europe website, Booking Terms & Conditions
8th-EPLS-Brussels-Booking-Form.docx