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.