Champagne reception

Five course meal with wine & liqueurs

Comedian Rod Woodward

BandHigh Time

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Reservation and payment details Tables for 10

£1080 - (£900 + VAT) if booked before 30.11.13

£1,200 - (£1,000 + VAT) if booked after 30.11.13

Places per person

£108 - (£90 + VAT) if booked before 30.11.13

£120 - (£100 + VAT) if booked after 30.11.13

I authorise the total payment of:

£ incl VAT

Preferred location

Near to the dance floor and stage

At a distance from the dance floor and stage

No preference

Booker detailsContact name: Company name:

Address:

Tel (direct dial): Fax:

Email address:

Company name and address for invoicing if different from above:

Payment method By 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 the back of card. This is mandatory to process your card.

Exact name on card:

Signature of card holder:

Please email this completed form to Natalie Flay, EUA Events & Projects Manager on natalie@eua.org.uk, or post to Camden House, Warwick Road, Kenilworth, Warwickshire CV8 1TH

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

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

Dinner DanceHilton Birmingham Metropole, NECFriday 7th February 2014