GPA - Europe

Registration form for May Conference Leiden 14 – 16 May, 2014

Please complete by either selecting from drop-down boxes or completing text entry, save as pdf and send by fax or email to Sandy Dunlop at GPA Administration Office.

Alternatively you can book packages by using the GPA Europe website. Select EVENTS and LEIDEN CONFERENCE and Register. Complete information requested and choose Method of Payment.

Title / First Name / Family/Surname
Choose an item. / Click here to enter text. / Click here to enter text.
Preferred Name on Badge / Click here to enter text. / Preferred Company Name on Badge / Click here to enter text.
Job Title / Click here to enter text. / GPA E Member? / ☐
Conmpany / Click here to enter text. / YP Discount Applicable? / ☐
Address 1 / Click here to enter text. / YP Discount available to Engineers with less than 5 years’ experience
Address 2 / Click here to enter text. / Preferred Currency / Choose an item.
Town / Click here to enter text. / Dietary Requirements / Choose an item.
Region/State / Click here to enter text. / Other Special Requirements / Click here to enter text.
Zip/Post Code / Click here to enter text. / Email / Click here to enter text.
Country / Click here to enter text. / Phone (inc. Country Code) / Click here to enter text.
Companion’s Full Name / Click here to enter text.
Conference Packages
Package Requested: Please refer to Conference Details / Choose an item.
Additional Accommodation Required
These will be requested but are not guaranteed until confirmed / 12 May
☐ / 13 May
☐ / 16 May
☐ / 17 May
☐
Other Nights Required / Please Provide Details Click here to enter text.
Payment Method / PayPal ☐ / Credit Card ☐ / American Express ☐ / Bank Transfer ☐
To pay by Credit Card or American Express, please send form and call Administration Office with Card details. Payment will be taken in Sterling. Do not send Card details by email or fax.
If you wish to pay by Bank Transfer, please advise GPA Europe who will provide an invoice with full bank details. Please confirm whether you wish to pay in Sterling or Euros.
Please note GPA Europe cannot accept any bank charges on money transfers.

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