IFLA Congress 2008 Ltd Credit Card Authorisation Form
Please clearly complete this form in BLOCK CAPITALS and return it, together with a signed photocopy of the credit card, to the IFLA Congress 2008 Ltd Registration Department. You should send these documents by fax or by postal mail. IFLA Congress 2008 Ltd Registration Department C/O Concorde Services Ltd, 50 Speirs Wharf Port Dundas, Glasgow G4 9TH, UK Fax: +44 (0) 207117 4561
Contact Information of Credit Card Holder
Mr
Family Name First Name(s) Company Mailing Address
Ms/Mrs
Prof
Other – Please specify
Postal Code (ZIP) Country E-mail Phone Fax + +
City
Credit Card Details and Authorisation
Payment
I hereby authorise IFLA 2008 to charge this credit card for the total amount of For the registration of : Participant No: * EURO (€)/ CAD$
*Please delete as appropriate
(Please insert the name of the participant of IFLA Congress 2008 Ltd) (Insert participant number from your acknowledgement).
As well as any amount due for any subsequent changes to his/her registration. Please find a signed photocopy of my credit card attached. Credit Card number Card Verification Code: Expiry date
(For Mastercard & Visa, last three digits on reverse of card) (For American Express, four digits on front of card)
/
Cardholder’s Name: Date: Cardholder’s Signature: