Date of Conference/Event: *
Organisation:
Registered Charity Number/ Company registration
Contact Name: *
Telephone Number: *
Fax Number:
Email Address: *
Invoicing Address:
Your Order Reference:
Name of Meeting:
Maximum Numbers Attending:
Arrival Time:
Departure Time:
Room Layout: (if complex, please e-mail plan)	Boardroom Theatre Circle of chairs Caberet Other (please state)
Breakout Rooms?
Times of Coffee Breaks/Meals (It is ESSENTIAL to provide these no later than 7 days prior to event date)	Morning Break Lunch Afternoon Break
Special Diets?
Overnight Accommodation:
A/V Equipment etc:
Day Delegate Rate Residential Delegate Rate Private Dining Canapés please specify -->	Hot/Cold 2 course Lunch Hot/Cold Finger Buffet Lunch Refreshments Only (No Lunch)
Date Form Completed:
* required

Cancellations: The Hilda Porter Conference Hall, Epworth and Princess Alice Suite must be cancelled in writing within 4 weeks prior to arrival date. All other rooms must be cancelled in writing within 14 days prior to arrival date. Failure to do this will incur a charge as outlined in our Terms & Conditions.