POWER NETWORKING

Delegate Booking Form - £20 per person

Name:

Company name:

Number of places required:       

Address:

 

 

Postcode:

20 word company profile for delegates list :

Nature of business:

Tel:

Fax:

Email:

Dietary
requirements:

Method of payment
(please tick)

cheque to follow email
cheque enclosed with this form

Print off and send with your cheque made payable to Lasan Restaurant Limited, 3-4 Dakota Buildings , James Street , St Paul 's Square, Birmingham , B3 1SD .

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