FILL & FAX BACK TO:0030-210 6747445 DATE:………………. ATTN :


AUTHORIZATION FORM
(PLEASE WRITE IN CAPITAL LETTERS)

I ( Name of Card holder )……………………………………………………………….hereby authorize BE TO BE TRAVEL & EVENT MANAGEMENT S.A. conference organazires to charge my credit card for services being rendered to me.

1.NATURE OF SERVICES:…………………………………………………………

………………………………………………………………………………………….

2.TYPE OF CARD :DINERS / VISA / MASTERCARD / AMERICAN EXPRESS ( please circle )

3.CARD NUMBER :….. ……………………………………………………………………...

4.CARD EXPIRY DATE:……..…………………/………………………

5.MEMBER SINCE (ONLY FOR AMERICAN EXPRESS CARDS):…………………..


6.CVC CODE (SECURITY CODE ON BACK SIDE OF THE CARD) :…………………………….

7.BILLING ADDRESS: :………………………………………………………………………

8.TEL NO ( RES / OFFICE ):………………………………………………

    MOBILE NO :………………………………………………..

9.PASSPORT NO:…………………………………………………………………………..

10.PRESENT ADDRESS & TEL NOS :……………………………………………………..


11.AMOUNT (EURO) : ………………………………………………………………………

I understand that the record of charges- in respect of services,submitted by you to the Card Center
(DINERS/VISA/MASTERCARD/AMERICAN EXPRESS)will neither bear my signature nor the imprint of my card,and I therefore,undertake to unconditionally honour & pay without demur & contestation,the said charges,as and when I am billed for the same by the Card Center.



AUTHORISED SIGNATURE :( as on credit card):……………………………………………….

DATE OF AUTHORISATION:………………………………………………………………………

With this form,please fax copy of both side of your card & copy of the passport.