CIU Meeting December 2015 Registration/Payment

{"elements":[{"isDiscrete":false,"hidden":false,"name":"1448274520253_0.35595336129819855_0.502310785714475","readOnly":false,"id":155195315,"type":"commentElement"},{"isDiscrete":false,"hidden":false,"name":"First Name","readOnly":false,"id":155194124,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Surname","readOnly":false,"id":155194131,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Title","readOnly":false,"id":155194155,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Company Name","readOnly":false,"id":155194248,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Telephone","readOnly":false,"id":155195036,"type":"phoneNumber"},{"isDiscrete":false,"hidden":false,"name":"email","readOnly":false,"id":155194465,"type":"emailElement"},{"isDiscrete":false,"hidden":false,"name":"Additional Delegates Full Name(s) and Email Address(es)","readOnly":false,"id":155194722,"type":"textBoxElement"},{"isDiscrete":true,"hidden":false,"values":[{"text":"----","value":"----"},{"text":"One Member (£25)","value":"25"},{"text":"One Non-Member (£50)","value":"50"},{"text":"Two Members (£50)","value":"50"},{"text":"Two Non-Members (£100)","value":"100"}],"name":"Please select payment based on number of delgates and membership status","readOnly":false,"id":155630206,"type":"paymentElement"}]}