4th International Workshop on THERMAL INVESTIGATIONS of ICs and MICROSTRUCTURES |
Please use BLOCK CAPITALS.
Last Name: | ______________________________________________________________ |
First Name: | ______________________________________________________________ |
Organisation: | ______________________________________________________________ |
Address: | ______________________________________________________________ |
______________________________________________________________ | |
Country: | ______________________________________________________________ |
Tel. N°: | __________________________ | Fax N°: | __________________________ |
E-mail: | __________________________ |
single room(s) double room(s) twin room(s) for nights from . . . . . . . . . . . . . . to . . . . . . . . . . . . . . |
City view: 710 FF per night for 1 or 2 persons (355 x 2 = 710 FF)
Beach view: 980 FF breakfast: 100 FF |
bank transfer (net amount = rate of the room + 100 FF bank fees)
payment to:
SOC HOTEL SOLEIL D'OR, SOFITEL - HOTEL MEDITERRANEE, 2, Bd Jean Hibert, 06400
Cannes, France, to the following account number:
BANQUE POPULAIRE DE LA CÔTE D'AZUR 15607 - 00002 - 02021089510 -
85, mentioning THERM98-B0706
credit card: please complete and return this authorization
I, the undersigned ______________________________________________________________
cardholder of the credit card N°. |
expiry date: __________________________
authorize the Sofitel LE MEDITERRANEE to debit my credit card in the amount of __________________ FF being the deposit for my reservation at the Hotel.
Signature:
Fax : +33 4 92 99 73 29