Copthorne Tara Hotel, Scarsdale Place, London, UK
28th January 2015 /
Please return one form per person to or fax: +44 (0) 1625 664 510
PERSONAL DETAILS
Member __
Deputy __
Please state the name of the member you are deputising for: / Sponsor __
Speaker __
Guest (£190 + VAT)* __
Experience
Please state how long you have been working in pharmaceutical outsourcing:
Surname / First Name
Telephone / Fax
Organisation Name / Email
Purchase order no. (if applicable)
Address
Special Requirements eg. specific diet, double room etc
ACCOMMODATION REQUIREMENTS
Please note that accommodation is available at the Copthorne Tara Hotel at a cost of £110.00 inc. VAT per night. Buffet breakfast is included. Delegates are responsible for their own hotel bill and a credit card number is required to hold the booking. Delegates will be liable for any cancellation charges due to late cancellation, no shows etc. Please tick below if you would like a room.
Tuesday 27th January __Credit Card Number: ______Exp. Date: ____ / ____
If you would like to book extra night/s accommodation please state the extra dates required:
DINNER – 27th January 2015 (please note dinner will be at your own expense)
I will attend dinner __ / I will not attend dinner __
PAYMENT DETAILS (guests only)
* Payment may be sent with form by post or on receipt of an invoice from PCMG
By Cheque made payable to PCMG, to PCMG, Chester House, 68 Chestergate, Macclesfield, SK11 6DY, UK
BACS payments: Please add name and company name to transaction details and advise in writing when payment has been made. Please also ensure bank charges are paid by your company.
HSBC, 16 Shepherd’s Bush Green, Shepherd’s Bush, London, W12 8PT, UK
Account Name: PCMG Account Number: 91489860 Branch Sort Code: 40-03-29
IBAN Number: GB 90 MIDL 40032991489860 SWIFT (or BIC) Codes: European: MIDL GB 22107R