ࡱ> []Zs  (jbjb !Zkk]FFFFF,r$F"T-D!!Op!p!p!p!p!p!,$&!i "-!  8!!.!! T E |!! FFQ ! Participation Contract/INVOICE Tier IIA MIPTV April 11-15, 2005 This document covers your Registration Fee, Accreditation and Participation in U.S. Independents Stand Instructions: Please carefully print or type in the required information on this Contract. This form must be returned to reserve your place in the US Independents Stand. Payment in full must be made by 2/15/05 to avoid a late fee. (If you see {FORMTEXT} on this page please hit alt F9 to prepare the fields for data entry) Payment may be made in Euros via PayPal or in US Dollars via check see page two of this agreement for instructions. This form must be filled out, printed, and signed. It should then be faxed or mailed to: U.S. Independents, Inc, 5603 Inverchapel Road, Springfield, VA 22151 Fax: 703-321-8098 Problems with fax call 703-321-9362 Stand Participation Fee Euros 4200 -- Shared table, minimum 4.5 hours of meeting time At the Tier IIA Level -- includes registration for one delegate and dedicated company listing in print guide and on the MIPTV Website. One additional participant from the same company may be added for a fee of 450 Euros. Company:  FORMTEXT       Name and Title:  FORMTEXT       Address:  FORMTEXT       City:  FORMTEXT       State:  FORMTEXT       Zip:  FORMTEXT       Phone:  FORMTEXT       FAX:  FORMTEXT       E-mail:  FORMTEXT       Website:  FORMTEXT       Signature/Date: ____________________________________________________________________________ I agree to pay all registration fees and acknowledge that upon signing this contract that I shall be indebted for the full amount of the participation option. I further acknowledge that this agreement is final and binding, and that all fees are non-refundable. Shared Table Reservation and One Registration Euros 4200 Plus Additional Participant Euros 450 Euros  FORMTEXT       TOTAL DUE (sum) EUROS  FORMTEXT       Please note: Participants are responsible for travel, per diem, and lodging costs. Hotel reservations are on a first-come, first-served basis. You may not reserve lodging through U.S. Independents until all fees are paid in full. Also Note: company information on this form will be used for any pre-MIPTV publicity, Guide Listing, and Stand Signage, so please ensure that information is accurate and legible. Additional Participant: Name:  FORMTEXT       Title:  FORMTEXT       Email:  FORMTEXT       (  FORMCHECKBOX YES, I want US Independents to assist me in reserving hotel accommodations Arrival Date: ______________________________ Departure Date: __________________________________ * See next page for directions on how to use PayPal or to pay by Check. To Pay by Check Payment may be made in US Dollars via check. Proceed to  HYPERLINK "http://www.xe.com" www.xe.com and determine the most current exchange rate between the Euro and US Dollar. Please use that exchange rate to calculate the total amount in US Dollars due. Make checks payable to US Independents, Inc. and forward them to: 5603 Inverchapel Road, Springfield, VA 22151. Phone: 703-321-9362. Pay Pal Instructions We have set up an account with Paypal that will allow you to pay US Independents by credit card in Euros. It is relatively simple, but does require that you log onto the paypal website, register your creditcard and/or bank account information. They accept Visa, MasterCard, Discover and American Express. Bank Account information will be required to lift any transactions limits. To Set up a New PayPal Account: Go to www.paypal.com  HYPERLINK "http://www.paypal.com" http://www.paypal.com Sign up for a free personal or premium account. Follow all directions and confirm your e-mail address. Go to Send Money Add your credit card to your account. Verify your account To enable Euro Capability: Go back into your Paypal Account Go to Financial Information Go to Currency Balance Highlight the radio button next to Euro Click on Open Balance Go back to Send Money after you have added your credit card and or bank account information: In "Recipient's E-Mail" type:  HYPERLINK "mailto:info@usindependents.com" diana.ingraham@usindependents.com Under "Type" select: Service Under Currency Option use Euro Balance Confirm information and click on the send button. Questions: Call Diana at 301-897-5511 or e-mail < info@usindependents.com< +B{1Vny} * , . 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