IOM Academy Registration - Distance learning courses in materials engineering

Purchase password(s) for modules

Name:

Job title:

Organisation:

Address:

Postcode / ZIP:

Tel:

Fax:

E-mail:

IOM3 Membership No:

Non-member

Members of the IOM are entitled to a 10% reduction on the prices shown.

I wish to purchase passwords for the module

Each password will allow a single registered user to access the module.

Passwords will be issued when payment is received, together with a tax invoice quoting The Institute of Materials, Minerals and Mining VAT Registration Number GB649164611. Prices for multiple users are available on application. You may also enroll for the IOM Academy Training Certificate, now or at a later time.

Modules

	Single module	£99.50 + VAT = £116.91
	Online examination (optional)	£40.00 + VAT = £47.00
	Certificate	£10.00 + VAT = £11.75


TOTAL	£
IOM Members deduct 10%	£-
TOTAL PAYMENT DUE	£

Methods of Payment

I wish to pay by:

Credit or Debit Card

Cheque

Bank Transfer

Please invoice me

Cheques should by made payable to The Institute of Materials, Minerals and Mining.

When paying through an overseas bank, £8.00 must be added to the total amount payable to cover transaction charges. Account No. 3759352 at Lloyds Bank, 8-10 Waterloo Place, LONDON, SW1Y 5NH (Sort Code: 30-00-08). Purchaser's name must be quoted on the draft.

Purchase order no:

VAT Registration no (EU Only):

If paying be credit or debit card, please complete the following details:

Cardholder's Name
Cardholder's Address (if different from the address above)


Card Number		Expiry Date
Issue Number (Switch only)

Please print and fax or send by post to:
Keith Wakelam, Business Development Director, Materials Processing Initiative (MPI), The Institute of Materials, Minerals and Mining, 1 Carlton House Terrace, London SW1Y 5DB, UK Fax: +44 (0)207 451 7406

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