Partnership Form

Complete the form below and we will be in touch shortly, alternatively to print the form as a Word document to send to us by post click here
I/we would like to sign up for C21 Partnership for the following issues:
Magazine and website:
One issue @ 195
Two issues @ 380
Four issues @ 695
Website only:
Three months @ 95
Six months @ 175
12 months @ 300
Category:
Region:
Payment:
Please invoice us
We would like to pay by credit card
Your details:
Only 'Address one' will appear in print, however both addresses will appear on the website.
Name
Position
Name of Company or Hospital
Address one
Postcode
Telephone
Email
Website
Name
Position
Name of Company or Hospital
Address two
Postcode
Telephone
Email
Website
Private Telephone no
Private website
Private email
Please supply up to 500 words of your choice, which will appear on our website