Form - Uninova

Fax
Ref.: INDIN’ 2011
9thIEEE International Conference on Industrial Informatics
To: Hotel Alif Campo Pequeno
Fax: +351217 826 210 / 217 826 222/ Phone: +351 21 795 41 16
From:
(Name)__________________________________________________________________________
(City)______________________________________ (Country)_____________________________
(Afiliation - Company/Institute/University/...)___________________________________________
(Tel.:)____________________________________ (Fax) _________________________________
(email)_______________________________________
Arrival date to Hotel (Day/Month/Year): ____/____/_______ Hour of arrival (hh:mm): __:__
I would like to book the following number of rooms for the period from
_______________________to___________________, in a total of _______ nights.
Single
58.5€
Twin
68.5 €
rooms
rooms
I understand that I will receive a confirmation of this reservation in the very near future.
Payment shall be made in EURO by Credit Card Type: Visa/Mastercard/AmericaExpressOther:
___________________________________
Card Nr.:_______________________________ Exp.Date(mm/yy) _____/_____ CVV2:_______
Name as it appears on Card _________________________________________________________
Signature: _______________________________________________________________________
Date:__________________________
_____________________________
Signature
=======================================================================
REPLY (to be used by the Hotel to confirm the reservation)
We confirm the reservation
Date:________________
______________________________
Signature