Last name | : | .......................................................................... |
First name | : | .......................................................................... |
Title | : | ....................... |
E-mail address | : | .......................................................................... |
Street | : | .......................................................................... |
City | : | ............................................................................. Postal code: .............. |
Country | : | .......................................................................... |
Tel. | : | .............................................. Fax: .............................................. |
Accompanying person(s) | : | .......................................................................... |
I would like to reserve a room at Danford's Inn to attend ILPS'97.
Arrival date : ................................... | Departure date : .................................. | Nr. of nights : ..... |
Single room [ ] | Double room [ ] | (Please tick appropriate box). |
Smoking [ ] | Nonsmoking [ ] | (Please tick appropriate box). |
[ ] |
Number of Credit Card : ............. ............. ............. ............. Expiry date : ......................... Name of the Cardholder : ......................................... Signature : ...................................... |
[ ] | Money order or Traveler's check for the amount of U.S Dollars ...................... is enclosed. |
Reservations will only be accepted with credit card guarantee or with enclosed check
Please return by postal mail or fax 1 copy of this form to Danford's Inn.
Date : .........................................
Signature : ...........................................