NEPIC Event Order Form

NEPIC Event Order Form Suppliers on Your Doorstep Event 09.30 - 16.30, Thursday 1st May 2014, Stadium of Light, Sunderland, SR5 1SU

Company Details Company Name: Address: Billing Address (if different):

NEPIC Membership Status: Member Non-Member

Booking Contact Details Name: Email Address: Contact No.

Your Order Please select your requirements from the options below: NEPIC Member Rates Non-NEPIC Member Rates

No. No. Member Delegate £50.00 Non-Member Delegate £100.00 Member Exhibitor (inc. 2 delegates) £300.00 Non-Member Exhibitor (inc. 2 delegates) £300.00

Delegate Details Please enter the detail of those attending: Delegate 1 Email Delegate 2 Email Delegate 3 Email Delegate 4 Email

Order Summary & Payment

Total Order Value: NB – all prices exclude VAT & will be added at the point of invoice.

Purchase Order No.* (*if applicable)

Signature:

Advance payment by credit card is available, with the exception of American Express Tick here if you wish to pay by Credit Card & we will call you to process the payment – please do not include card details on this form.

Please return your completed registration form to: [email protected] or alternatively fax to 01642 442 561

Cancellation Policy: Please advise of cancellation by email 7 working days prior to the date of the event. After this time any associated invoice will remain for payment in order to cover administration & delegate costs incurred by us from the venue.

Data Protection: The information you provide will be added to the NEPIC database & used for NEPIC purposes only, which may include but not limited to: mailing of additional information about other services that we feel may be of interest to you. Please tick here if you DO NOT wish to receive further information.

NEPIC Limited. The Wilton Centre, Wilton, Redcar TS10 4RF & RTC North, 1 Hylton Park, Wessington Way, Sunderland SR5 3HD 01642 442 560 / 0191 516 4400 | www.nepic.co.uk | [email protected]