form robbins aplication upw 2015, london
TRANSCRIPT
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8/9/2019 Form Robbins Aplication UPW 2015, London
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APPLICATION FORM
TONY ROBBINSSEMINARUNLEASH THE POWER WITHIN
London, 26-29 March 2015
Offert valid while seats last at these prices:
Please tick the option you prefer
_ 1 SOLITAIRE(Best seats in the house - first 4rows, Exclusive briefing with Tony,
One meal supplied on Day 2,3,4, Relaxing mini-massage): 3.045euro + vat Full Price: 4.090euro + vat
_ 1 DIAMOND
(Seats in first rows, Exclusive briefing with Tony,
One meal supplied on Day 2,3,4, Relaxing mini-massage): 1.990euro + vat Full Price: 3.250 euro + vat
_ 1 VIP(central area): 947euro + vat Full Price: 1.690 euro + vat
_ 1 GOLD(general): 699euro + vat Full Price: 1.090 euro + vat
Hi-Performance srl - Via Federico Cesi, 72 - 00193 Rome - ITALY Tel: +39 06 36005152 - Fax: +39 06 36000752 - E-mail: [email protected] - www.hiperformance.it
Payment
CREDIT CARD _ (please tick the box if you choose this option)
Type:
Owner
Credit Card nr. ________________
Valid until ___/___/___ CV2___(3 digits safety code printed on the back of your card)
SIGNATURE
(obligatory)
BANK TRANSFER_(please tick the box if you choose this option)
Beneficiary HIPERFORMANCE srl
Bank Banca Popolare di SondrioACCOUNT#
2849/74
Address Via del Tritone 205 - 00187 ROME - ITALY
Iban IT 53 C 05696 03226 000002849X74
SWIFT / BIC code POSOIT22
Remark for thetransaction:
Tony Robbins Seminar 2015
I request an invoice issued to:(Invoice has to be requested within this form, by filling out all required data. If information is not complete, the invoice will be issued on behalf of the participant.)
Company name
VAT nr. ________________
Address n
Zip code City
Country
Email address to receive the invoice
Invoice
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ParticipantPERSONAL DATA
Name
Surname
Date of birth
Profession
Address n
Zip code City
Country
Home Ph. Office Ph.
Mobile Ph. Fax nr.
Email
To confirm your application, please fill out this form (front/back)
and send it together with copy of your payment to email
[email protected] contact +400745652220
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8/9/2019 Form Robbins Aplication UPW 2015, London
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