<p> NEPIC Event Order Form Suppliers on Your Doorstep Event 09.30 - 16.30, Thursday 1st May 2014, Stadium of Light, Sunderland, SR5 1SU</p><p>Company Details Company Name: Address: Billing Address (if different):</p><p>NEPIC Membership Status: Member Non-Member</p><p>Booking Contact Details Name: Email Address: Contact No.</p><p>Your Order Please select your requirements from the options below: NEPIC Member Rates Non-NEPIC Member Rates</p><p>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</p><p>Delegate Details Please enter the detail of those attending: Delegate 1 Email Delegate 2 Email Delegate 3 Email Delegate 4 Email</p><p>Order Summary & Payment</p><p>Total Order Value: NB – all prices exclude VAT & will be added at the point of invoice.</p><p>Purchase Order No.* (*if applicable)</p><p>Signature:</p><p>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.</p><p>Please return your completed registration form to: [email protected] or alternatively fax to 01642 442 561</p><p>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.</p><p>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.</p><p>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]</p>