Friends of EventWell Payment Form Name(required) Email(required) Phone Number(required) Company Name (NA if not applicable)(required) Billing Address(required) Card Type Select one(required) Mastercard Debit Mastercard Credit Visa Debit Visa Credit Other Debit/Credit Card Number(required) Issue Number (if applicable)(required) Card valid from date (if applicable) Card valid to date (required) 3 digit card secure code (CVC) (required) I hearby give EventWell Lts authorisation to set up a recurring payment on the above card details for the following Friends of EventWell membership (please slect which applies)(required) Friends of EventWell Professional (Europe) – €8 per month Friends of EventWell Professional (Europe) – €80 per year Friends of EventWell Starter (Europe) – €6 per month Friends of EventWell Starter (Europe) – €60 per year Friends of EventWell Professional (North America) – $10 per month Friends of EventWell Professional (North America) – $100 per year Friends of EventWell Starter (North America) – $7 per month Friends of EventWell Starter (North America) – $70 per year Digital Signature (required) Signature Date(required) Send Δ
