credit card form test

First name*

Surname*

Email address*

Telephone number (preferably mobile) incl. country code*

Job title/Position*

Organisation (will be added to the name badge)*

Billing organisation*

Billing organisation address*

Billing organisation postal code, city and country*

Upon registration we will send you an invoice. If you would like to pay by credit card, insert the details below.
I would like to pay using a credit card

We will bill you and then delete the payment information (read more). Your credit card will list CONFENT OU as the merchant for the transaction.

Card number*

Cardholder name as it appears on the card*

Expiry date*

Security code*

Attendance details:

In addition to the conference, I will join a site visit on October 17th (EUR 60 excl. VAT)
In addition to the conference, I will join Gala Dinner at Seaplane Harbour (EUR 60 excl. VAT)

Notify me about news and updates regarding the conference.*
YesNo

I consent to have my submitted details stored and processed by the organisers as per privacy policy to attend the event (includes final participation email)*.