Travel Centres Conference 2025
Agents' Registration Form
Registrant Company Information
Please complete for billing information
Your name
*
First Name
Last Name
Email Address
*
example@example.com
Contact Number
*
-
Country Code
-
Area Code/Mobile Prefix
Phone Number
Your company name
*
Business address
*
Street Address
Street Address Line 2
Town/City
County
Eircode / Postcode
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Delegate information
Please complete the information of all delegates that will attend
Delegate 1 name
*
First Name
Last Name
Delegate 1 Email
example@example.com
Delegate 1 phone number
-
Country Code
-
Area/Mobile prefix
Phone Number
What meals will this delegate attend?
*
Friday evening dinner
Saturday lunch
Saturday Gala Dinner
Please advise any special dietary needs (eg. vegan, vegetarian, coeliac)
Add another delegate
Delegate 2 name
First Name
Last Name
Delegate 2 Email
example@example.com
Delegate 2 Phone number
-
Country Code
-
Area/Mobile prefix
Phone Number
What meals will this delegate attend?
Friday evening dinner
Saturday lunch
Saturday Gala Dinner
Please advise any special dietary needs (eg. vegan, vegetarian, coeliac)
Add another delegate
Delegate 3 Name
First Name
Last Name
Delegate 3 Email
example@example.com
Delegate 3 Phone number
-
Country Code
-
Area/Mobile prefix
Phone Number
What meals will this delegate attend?
Friday evening dinner
Saturday lunch
Saturday Gala Dinner
Please advise any special dietary needs (eg. vegan, vegetarian, coeliac)
Add another delegate
Delegate 4 Name
First Name
Last Name
Delegate 4 Email
example@example.com
Delegate 4 Phone number
-
Country Code
-
Area/Mobile prefix
Phone Number
What meals will this delegate attend?
Friday evening dinner
Saturday lunch
Saturday Gala Dinner
Please advise any special dietary needs (eg. vegan, vegetarian, coeliac)
Add another delegate
Delegate 5 Name
First Name
Last Name
Delegate 5 Email
example@example.com
Delegate 5 Phone number
-
Country Code
-
Area/Mobile prefix
Phone Number
What meals will this delegate attend?
Friday evening dinner
Saturday lunch
Saturday Gala Dinner
Please advise any special dietary needs (eg. vegan, vegetarian, coeliac)
Add another delegate
Delegate 6 Name
First Name
Last Name
Delegate 6 Email
example@example.com
Delegate 6 Phone number
-
Country Code
-
Area/Mobile prefix
Phone Number
What meals will this delegate attend?
Friday evening dinner
Saturday lunch
Saturday Gala Dinner
Please advise any special dietary needs (eg. vegan, vegetarian, coeliac)
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Confirm your booking
Please accept terms & conditions below
*
I understand that if I cancel within one week of the conference or fail to show up on the day, I/we will be liable for full cancellation fees.
I understand that the personal data on this form will be shared with the venue and Travel Centres Conference partners as required during the course of the conference planning and management. I have permission to authorise the data to be shared.
Submit
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