Hilton Birmingham Metropole, NECFriday 8th February 2013

DinnerDanceChampagne receptionFive course meal with wine & liqueursComedian – Jamie SutherlandDancing to top band – Hot StuffCharity raffle

Tickets:£85 + VAT per person for bookingsreceived with payment before 15.11.12

£95 + VAT per person for later bookings

(Bookings accepted for tables of 10 or individual places)

Five course meal with wine & liqueurs

ComedianJamie Sutherland

MusicHot Stuff

Sponsored by

Friday 8th February 2013Dinner Dance

Please fax this completed form to Claire Pitt, EUA Events & Projects Manager on 01926 513726, post it to herat Camden House, Warwick Road, Kenilworth, Warwickshire CV8 1TH or email it to claire@eua.org.uk

My company wishes to reserve:tables for 10 @ £850 + VAT (£950 + VAT if booked after 15.11.12)

places @ £85 + VAT per person (£95 + VAT if booked after 15.11.12)

*We prefer to be located:near to dance floor and stage at a distance from dance floor and stage no preference

*Please tick as applicable - allocation in order of receipt of bookings

PAYMENT DETAILSBooking Fee:Tables for 10: to 15.11.12 * £1020.00 (£850 + VAT) After 15.11.12 * £1140.00 (£950 + VAT)

Individual places: to 15.11.12 * £102.00 (£85 + VAT) After 15.11.12 * £114.00 (£95 + VAT)

*Please tick relevant box.

I authorise the total payment of £ .......................................................... (incl. VAT)

PAYMENT METHODBy cheque payable to EUA (enclosed) (Payment must accompany booking)

Mastercard Visa

Card Number:

Start Date: Expiry Date: Issue No: Security Code:

(if applicable) Last 3 digits on back of card.This is mandatory to process your card.

Exact name on card: Signature of Card Holder:

BOOKER DETAILS

Contact name: Company:

Address:

Tel (Direct Dial): Fax:

Email:

Company Name and address for invoicing if different from above:

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

A confirmation letter and VAT receipted invoice will be sent to you, along with details of specially discountedaccommodation rates at the Hilton Birmingham Metropole Hotel.