Gold Package Order Form

To order the Gold Conference Package, simply complete the form below. You will then be taken to a secure on-line payment page, provided by PayPal, where you can pay for your listing by credit or debit card. If you do not wish to pay on-line, please email us for further instructions.

Part 1 of 2 - Your Event Information

Conference title:
Date:
Location (town and country):
Name of organiser:
Contact telephone number:
URL of your event website:
Featured Event text (max 250 words):
Logo - If you would like to add an image to your featured event, please email this to us at web_enquiry@medicaldevicemarketer.com
Banner advertisement - this should be 468 x 60 pixels, no more than 20 KB and ideally saved as a gif. Email the image to web_enquiry@medicaldevicemarketer.com

By entering my name in the signature field below, I confirm that I would like to order the Gold Conference Package, which is priced at £175. I also consent to receive communications from Medical Device Marketer via email, mail, telephone or fax relating to this service.
Signature: