ࡱ> bda% nbjbj%% HZGGAlr r r r < ,R. B( ( ( ( O#D0-O------$H1 h3-i-"O-#( (  .###d8( ( 0-#0-# #h+-( 5/(Zr O+-".0R. ,4(4-# Participation Contract/INVOICE Tier II MIPTV featuring MILIA April 3-7, 2006 This document covers your Registration Fee, Accreditation and Participation in the 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 2/17/06 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 mailed to: U.S. Independents, Inc c/o 5816 Wyngate Drive, Bethesda, MD 20817 Questions: Call Meg at 207.729.3274 or Diana at 301.897.5511 (if you are paying by check please enclose payment) Stand Participation Fee Euros 3,590 -- Shared pre-assigned space 3 hours minimum per day At the Tier II 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 480 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 3590 Plus Additional Participant at Euros 480 Euros  FORMTEXT       TOTAL DUE (sum) EUROS  FORMTEXT       Please note: Upon receipt of this contract and all fees, a subsidiary form that includes the option to request hotel reservations will be forwarded. You will need to fill out the subsidiary form and return it as directed. Please be sure to fill out the subsidiary form legibly and accurately. The information contained in it will be used for your dedicated company listing in the print guide and on the website. Participants are responsible for travel, per diem, and lodging costs. Hotel reservations are on a first-come, first-served basis. Additional Participant: Name:  FORMTEXT       Title:  FORMTEXT       Email:  FORMTEXT       (  FORMCHECKBOX YES, I want US Independents to assist me in reserving hotel accommodations * 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. Please contact Meg or Diana for the appropriate exchange rate to be used and the total due in Dollars. Make checks payable to US Independents, Inc. and forward them to: 5816 Wyngate Drive, Bethesda, MD 20817 phone: 301.897.5511 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:diana.ingraham@usindependents.com" diana.ingraham@usindependents.com (you must use this address) Under "Type" select: Service Under Currency Option use Euro Balance Confirm information and click on the send button. 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