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Registration Form FESI 1 Day CPD Workshop - 23 September 2014 (Registration Closing date: 18 September 2014) Sponsored by Advances in Rolling Bearing Fatigue DELEGATE DETAILS Title First Name Last Name CONTACT DETAILS Contact Name (if different from above): Co./Org. Name: Address: Post Code: Fax: Tel: E-mail Address: Authorised Signature: Date: PRICES Registration price includes lunch, morning and afternoon refreshments and workbook • Cost per delegate: £170 + VAT (£204.00) • Cost per member: £130 + VAT (£156.00) Please tick all appropriate boxes • Student rate: £60 + VAT (£72.00) PAYMENT DETAILS I enclose a cheque for: £ made payable to FESI Ltd Please invoice my Co./Org. – Purchase Order Number: Our VAT No.: (£10 + VAT admin charge will be added) Credit Card no. (Visa/Mastercard only): Cardholder Name: 3 digit security number: Cardholder/Invoice address (if different from above): Post Code: Cardholder Signature: SEND COMPLETED FORM TO Poul Gosney FESI – UK Forum for Engineering Structural Integrity Whittle House, 410 the Quadrant, Warrington, WA3 6FW, UK T: +44 (0)1925 843429, F: +44 (0)1925843498, E: [email protected] Expiry date: