How to Join LANPAC

Fill in the details on screen and click the SUBMIT button, alternatively print this page and fax to 01772 412129

Name:

Date of Birth (DD/MM/YY):

Position:

Organisation:

Address:

Telephone No:

e-mail address:

Number Of Employees:

Please tick the appropriate box

Please send me an invoice to cover membership of 2007-2008

Please contact me to arrange a mutually convenient appointment to discuss membership

Once you have submitted this form successfully an e-mail of confirmation will be sent back to you. If you do not recieve this confirmation within 24 hours then please print the completed form and fax 01772 412129.