<p>Image Sensors Automotive 2017 24-26 April 2017 | Radisson Blu Scandinavia Hotel, Dusseldorf, Germany</p><p>Return Completed form via email to [email protected]</p><p>1. Please select the price below:</p><p>Super Earlybird Early Bird Rate Standard Rate Final/Onsite Rate Expires 14 Dec 2016 Expires 10 Feb 2017 Expires 14 April 2017 Until event date 2 Day Conference €799 €899 €999 €1099 *Excludes German VAT</p><p>2. Complete attendee details (boxes below can be typed into directly and have no word limit):</p><p>Mr/Mrs/Dr/Prof/Ms: First name: Family name/surname: Job title: Organisation: Address: VAT Number (We cannot complete your registration without this) Direct E-mail address 1: Telephone: </p><p>3. Payment methods: I send this document acknowledging that it is a legally binding registration. (Please tick)</p><p>Invoice my company: If you would like to be invoiced in Pounds or US Dollars, please select here: Invoice me in £ Invoice me in $ Invoices in Euros or US Dollars will be calculated at that day’s exchange rate. - Purchase Order Number Invoices cannot be issued without receipt of a PO number at the time of booking </p><p>Credit card: (will be charged in £STG at the current exchange rate) to my Visa | Mastercard | American Express</p><p>Card number: Start Date: Expiry date: Security code/CV2: Cardholder’s name: Card’s billing address (if different from above): </p><p>Cheque/banker’s draft (made payable to Smithers Information Ltd)</p><p>Bank transfer (Banker’s information for credit transfer payments can be found under the terms and conditions below) </p><p>I understand that by confirming my booking, I have read and accept the Terms and Conditions for this booking (see below) and I am authorising a charge to the credit card number provided for the selected event. (Please tick box and sign below in order to complete registration)</p><p>SIGNATURE ______Date ______</p><p>Terms & Conditions</p><p>The following terms and conditions are for Smithers Information Ltd. Please read them carefully and check the box in the registration form above to acknowledge you have read and understood them.</p><p>Conference Fees The conference fee includes entry to the conference sessions, full documentation, lunch and refreshments. However, fees do not include delegate travel and accommodation. There will be no retrospective discount if full details including Membership status are not provided at the time of booking.</p><p>PLEASE NOTE Credit card payments (in £STG) will be necessary if your booking is made less than 10 business days prior to the start of the event. Where fund have not been received in advance, delegates will be required to supply credit card details at registration in order to gain entry to the conference. This credit card will be charged on-site and in £STG only. Current exchange rates and bank charges will apply.</p><p>Cancellations Cancelling 15 working days or more prior to the event A cancellation request must be made in writing to the operations manager Sharleen Lyseight at [email protected] A 20% handling fee applies to all cancellations.</p><p>Cancelling less than 15 working days prior to the event No refunds can be made for any delegate cancelling for any reason during this time. Please note this still applies if funds have not yet been received.</p><p>Substitutions Delegates can provide a substitute at any time online or by contacting the sales manager. No cancellation fees apply if a delegate place is substituted Note Smithers does not accept liability for any loss of or damage to the personal effects of delegates attending the conference. Smithers reserves the right to cancel, defer or otherwise modify the proceedings without prior notice.</p><p>Visas Delegates requiring visas should request a visa invitation letter from Smithers at the time of booking; ensuring that sufficient time is left for applications to be completed. Delegates are then responsible for contacting the relevant/appropriate embassy themselves. Smithers can do nothing further to assist in this process. </p><p>------Banker’s information for credit transfer payments</p><p>HSBC Building 2, Etruria Office Village, Forge Lane, Festival Park, Stoke on Trent, ST1 5RQ, UK</p><p>GBP Account Euro Account US Dollar Account Sort Code: 40-28-56 Sort Code: 40-05-15 Sort Code: 40-05-15 Account number: 60022020 Account number: 74631492 Account number: 59414161 Swift Code: MIDLGB2188R Swift Code: MIDLGB22 Swift Code: MIDLGB22 IBAN: GB66MIDL40285660022020 IBAN: GB70MIDL40051574631492 IBAN: GB63MIDL40051559414161</p><p>Please quote the invoice number when making payment by bank transfer</p><p>VAT No: GB100 2043 06 Payment terms – 30 days Credit control: Sue Leighton 01939 252310 or email [email protected] </p>