Grange Wellington Hotel, 71 Vincent Square, London, UK
6th April 2017 /
Please return one form per person or fax: +44 (0) 1625 664 510
PERSONAL DETAILS
Member __
Deputy __
Please state the name of the member you are deputising for: / Sponsor __
Guest (£190 + VAT)* __
Please note: Non-member delegates are restricted to Pharmaceutical Company staff or Consultants working for Pharma Companies. CRO/Providers are not eligible due to agreement with the Workshop Sponsor.
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 availableat the Grange Wellington Hotel at a cost of £150 exc. VAT per night. Please note this rate is guaranteed until 6th Marchafter which the hotel reserves the right to charge a prevailing rate. Continental 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.
Wednesday 5th April 2017 __Credit Card Number: ______Exp. Date: ____ / ____
If you would like to book extra night/s accommodation please state the extra dates required:
DINNER –5th April 2017 (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 90MIDL 40032991489860 SWIFT (or BIC) Codes: European: MIDL GB22107R