Mr./Mrs./Ms./Dr./Other
First name
Last name
Job title
Organization / Company
Nature of business
Address
Country Tel. No.
E-mail Fax No.
Method of payment
Please note : Payments must be received with booking. Payment will be acknowledged with an invoice.
Please check the following boxes. I would like to attend the:
[ ] symposium only, US$250
[ ] workshop only, US$250
[ ] workshop and symposium, US$500
Cheque / bankers draft enclosed for [ ] US$250 [
] US$500
payable to DELTA TRADING CO.
Please charge credit card for [ ] US$250 [ ] US$500
[ ] Master Card [ ] Visa [ ]
AMEX
Card Number __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Exp. date __ __/__ __ __ __
Issue No.……………………
Signature:…………………………………… Card holder name:……………………………………