Use BLOCK CAPITALS
Last Name:
| ______________________________________________________________
| First Name:
| ______________________________________________________________
| Organisation:
| ______________________________________________________________
| Address:
| ______________________________________________________________
|
| ______________________________________________________________
| Country:
| ______________________________________________________________
| |
Tel. N°:
| __________________________
| Fax N°:
| __________________________
|
E-mail:
| ____________________________________________________________
|
Please reserve (tick as appropriate).
single room(s)
double room(s) / twin room(s)
|
for ___________________ nights,
from ___________________ to ___________________
|
Hotel (please indicate selected hotel): |
___________________________________________________________ |
___________________________________________________________ |
___________________________________________________________ |
___________________________________________________________ |
___________________________________________________________ |
They are 2 ways to pay the registration fee (tick one):
cash
by credit card:
Visa Card
Mastercard
Eurocard
American Express
Diners
Credit Card N°
|
|
Expiry Date:
|
|
Name of Cardholder: . . . . . . . . . . . . . . . . . . .
| Total: . . . . . . . . . . . . . . . . . . .
|
Date / Signature:
A one night deposit is required to guarantee the room.
The form is to be returned to the selected hotel before 24 August 2000.