Registration Form

Number of Employees ICT Company (Total number of employees in organisation) User Company (employees within IT department only)	Subscription Rates
1-5	£85	+ VAT
6-10	£275	+ VAT
11-20	£500	+ VAT
21-50	£675	+ VAT
51+	£850	+ VAT
Affiliate Companies (organisations offering services to Momentum members, such as legal, financial and recruitment companies)	£750	+ VAT

Name:

Company:

Company Description:

Email:

Company Address:

Company Telephone:

Company Fax:

Website:

Number of Employees based in NI:

Comments:

Security Code:

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