National Optometric Conference
2nd – 4th November 2011
Chesford Grange Hotel, Kenilworth, Nr Warwick, Warwickshire
BOOKING FORM
Please use this form to book only one delegate. Please use a separate form for each additional delegate.
Please complete and return this form together with your payment to:
Linda Marriott
AOP, 2 Woodbridge Street, Clerkenwell EC1V 0DG
Fax : 020 7251 8315
Email: lindamarriott@aop.org.uk
Payment must be made at time of booking.
Name: (in the format you would like to appear on your name badge)
Mrs / Mr / Ms / Miss / Other.................................... AOP Membership No....................................................
Address:………………………….…………..……………………………………………............………………………
………………………………….…………………………………………………………………………............………..
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Postcode…………………............Daytime Tel. No………..…………........................................................………
Email:…………………………………………………………………….....................................………………………
If you are a representative of an ROC/LOC/AOC, please indicate which one:
If you are a representative of a primary care organisation, please indicate which one:
We are hoping to arrange a tailored ‘Peer review’ session for Dispensing Opticians; to help with numbers
please indicate if you are a Dispensing Optician Yes No
Please advise any special dietary requirements:
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Package and fees (incl VAT) (please indicate your choice by ticking the box)
NOC Resident Delegate £540.00 incl VAT
Included Wednesday: Evening buffet & overnight accommodation
Thursday: Breakfast, NOC programme inc. lunch, black tie Awards Dinner & overnight accommodation
Friday: Breakfast, NOC programme inc. lunch
NOC Resident Spouse/Partner £140.00 incl VAT
Included Wednesday: Evening buffet & overnight accommodation
Thursday: Breakfast, black tie Awards Dinner & overnight accommodation
Friday: Breakfast
NAME..............................................................................
NOC Non-Resident Delegate £330.00 incl VAT
Included Thursday: NOC programme inc. lunch & black tie Awards Dinner
Friday: NOC programme inc. lunch
LOC Nominated Free Place free of charge
Only one free place per participating LOC
Please confirm that you will require the free hotel accommodation on Wednesday only
Thursday only
Both nights
Payment details
Mastercard [ ] Visa [ ] Switch [ ] Maestro [ ]
Valid from:……./……. Expires:……./……… Security code:…..../….../..….. Issue no .…..................
Billing address if different from address overleaf........................................................................................................
Name as shown on card..................................................................................................................................
or I enclose my cheque made payable to The Assoc. Of Optometrists
Tick the relevant box(es) to allow the AOP to pass your details to approved third parties who may contact you
regarding their relevant products or services :- by phone by email by post
The NOC is kindly sponsored by:
Established in 1996 we are an independent supplier of new, ex demo & quality refurbished Optometry equipment.
We also buy used equipment across the UK. Call us today on 01527 501077 or visit our website
www.hansoninstruments.co.uk
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QAF 88 Rev 1