electronica 2012 Registration

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by using #elec12 in Twitter.

Registration Form:

Please note that you can only receive 1 online ticket per e-mail address. In case you would like to request another ticket, please submit your request by using an alternative e-mail address.

(fields marked with * are mandatory)

⁽¹⁾ Yes, I’d like to join you at electronica 2012, please send me a free ticket!

* First Name:

* Last Name:

* Company Name:

* Address

Address 2

* Postcode:

* City:

* Country:

* E-mail address:

* Phone:

Fax:

Account Number:

PIN Number:

* What is your primary job role?

if other:

* What is the primary use for the products you purchase from Farnell element14?

if other:

* Where did you hear about our free electronica tickets?

if other:

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⁽¹⁾ Farnell element14 will be using your e-mail address ONLY to send out the free voucher code to receive your online ticket. If you would like to receive further information about Farnell element14, please make sure to tick the permission boxes above.

Please note that registration closes on 31st October 2012. After that date, kindly contact your local sales office for further information on ticket availability.

Please note that registration closed on 7th November.