Full Postal Address:

Post Code:

Country:

Email:

Phone Number:

DATE(S) REQUIRED

Module 1:
29-30 March 2004

Module 2:
Dates to be agreed with participants

I would like to book for the following:
Reserve a place - £100 + VAT (Total = £117.50) per person Full payment for Module 1 - £360 + VAT (Total = £423.00) per person (IMC members: Full payment for Module 1 - £324 + VAT (Total = £380.70) per person) Full payment for both Modules - £720 + VAT (Total = £846.00) per person (IMC members: Full payment for both Modules - £648 + VAT (Total = £761.40) per person)

EITHER:

Send cheques made payable to "Management Magic", together with a printed copy of this form, to:

Management Magic, Pentre House, Leighton, Welshpool, Powys SY21 8HL United Kingdom
(UK sterling cheque or bank draft only please)

OR

Please charge my credit/debit card below: (Details are secure as noted below)

Credit card Type: Required
(Please select your card type)

Visa MasterCard Visa Delta JCB Switch Solo

Credit card number: Required
(eg: 1234 5678 9012 3456)

Expiry date: Required
(eg: 07/02)

01 02 03 04 05 06 07 08 09 10 11 12 / 01 02 03 04 05 06 07 08 09 10 11 12

Issue Number: Required for Switch

If any credit card details differ from delivery address information above please supply full details below:

Name on card

Address for card

Please note that if you do not want any of the information provided to be shared with selected third parties who may approach you with their goods or services please tick here:

Any comments eg special needs etc please tell us here:

Please tell us how you heard about us:

NOTE:

This site is on a Secure Server and all details sent on this form will be encrypted.

Since we are using the Trusted Certificate of the ISP (NewNet) you will receive a warning message indicating that our name differs from the certificate holder. Please note that this is correct and you should proceed with the transaction.