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Booking your coursePageBooking form125Terms and conditions126Venues127Contact numbers127Index128124

125Booking formRef. Number:L&D Directory 2012 1165ENEvent detailsEvent title:Event code:Event date:Location:Delegate detailsTitle: Mr Mrs Miss Ms OtherFull name:Job title:Direct tel no:Fax no:Email:Membership no. (if applicable):Company detailsCompany name:Company address:Town:Postcode:Main switchboard no:Contact detailsSame as delegate:Contact name:Job title:Direct tel no:(please photocopy this form)Payment detailsPlease invoice my company:Purchase order no. (if required)I enclose a cheque payable to CIM Holdings LtdI wish to pay by:VISA MastercardDiners Card American ExpressCredit card number:Card security code:Mastercard/Visa - last 3 digits on signature stripAmerican Express - 4 digits on front of cardExpiry date:Valid from:Signature:By signing above I agree to accept CIM's booking terms and conditions.Date:We would like to contact you regarding other training products andqualifications that may be relevant to you.Yes, I wish to receive information about training and qualifications from The Chartered Institute of Marketing. byPost Email Telephone(tick all that apply)From time to time, we are approached by other companies who would like toinform you of relevant business and marketing information. These companiesare strictly controlled and we never disclose member information to them.Yes, I wish to receive information from third partiesbyPost Email Telephone(tick all that apply)Book online at:www.cim.co.uk/trainingFax this form to:+44 (0)1628 427267Mail this form to:Client ServicesThe Chartered Institute of MarketingMoor Hall, CookhamBerkshire SL6 9QHMMYYDDMMYYMMYY1165EN