COG - Membership renewal

Contact Details

Please fax to: 01582 461 928 or mail to: COG International Ltd, PO Box 314, Harpenden, Herts, AL5 3BD, UK We should like to renew our membership of the Component Obsolescence Group and accept the terms of reference agreed by the Group. You may either print this form to mail or fax, or pay on-line via our secure server
Company
Address
Post Code
Contact Name
Phone
Fax
Email
Field of Activity
Invoice Number

Notes: This data may be used by the Component Obsolescence Group to inform you of future COG events and membership benefits. Please click this box if you do not want your contact details sent to selected third parties supplying goods and services in the obsolescence management field.

Payment Method

Method of Subscription payment
Please check applicable box	UK Membership fee £840 + 15% VAT = £966.00
	Non-UK Membership fee £913.50

Please find cheque attached	(If sending by post)
Please find purchase order attached	(If sending by post)

You may either:
Print the form to fax or post (You may enter credit card details by hand if required.)
Or pay on-line by credit card using our secure server
Payment by Credit Card	Note: Subject to a 3% charge
Card type	Visa MasterCard Amex
Card number
Security Number	Last three digits
Expiry Date	Month Year
Cardholders Name
Billing Address

Card Holders Signature	________________________________