Hotel Reservation Form

HOTEL RESERVATION (Hotel Reservation Form to be send only by fax for security reasons)

MR.

MS.

DR.

M.I.:

Last Name:

First Name:

Affiliation:

(Dept., Univ. or Company)

Title:

Mailing Address:

Dept.:

City: State: Zip: Country:

Phone: (country and area code)
( )

Fax: (country and area code)
( )

E-mail:

Sharing with :

Hotels (select option):

Special needs:

	Arrival	Departure
Date
Hour
Airline-flight#

Cancellation
Hotel deposits will be refunded infull provided that cancellation is received no later than 45 days prior to arrival. Thereafter, the cost for the first night of accommodation will be charged.

Reservation
Visa Master Card American Express

Nº Expiration (month/year):
Name as it appear on credit card:

Card holder signature: __________________________

Print, sign and send this Form to the fax (56-2) - 274 2789

Print Document

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