Dinner Dance 2014

Champagne

Five course meal with

Comedian

Band

reception

wine & liqueurs

Rod Woodward

High Time

sponsored by:

Dinner Dance Hilton Birmingham Metropole, NEC Friday 7th February 2014

Reservation and payment details

Payment method

Tables for 10

By cheque payable to EUA (enclosed) (Payment must accompany booking)

£1080 - (£900 + VAT) if booked before 30.11.13

Mastercard

£1,200 - (£1,000 + VAT) if booked after 30.11.13

Visa

Card number:

Places per person £108 - (£90 + VAT) if booked before 30.11.13

Start date

£120 - (£100 + VAT) if booked after 30.11.13

Expiry Date

I authorise the total payment of: £

Issue No

Security code

If applicable

Last 3 digits on the back of card.

This is mandatory to process your card.

incl VAT

Preferred location

Exact name on card:

Near to the dance floor and stage At a distance from the dance floor and stage

Signature of card holder:

No preference

Booker details Contact name:

Company name:

Address: Tel (direct dial):

Fax:

Email address: Company name and address for invoicing if different from above:

Please email this completed form to Natalie Flay, EUA Events & Projects Manager on natalie@eua.org.uk, or post to Camden House, Warwick Road, Kenilworth, Warwickshire CV8 1TH A confirmation letter and VAT receipted invoice will be sent to you, along with details of specially discounted accommodation rates at the Hilton Birmingham Metropole Hotel.

Cancellation policy: In the event of cancellation of your booking: -Not later than 31/12/12: full refund less £10 admin charge per person -Not later than 20/01/13: 50% refund -After 20/01/13: no refund