** PLEASE PRINT :

Hotel Name being reserved_______________________________________________ NAME:   #Prof / Dr / Mr / Ms / Mrs (First name)_______________________ (Last name) __________________________ Address _______________________________________________________________                _______________________________________________________________ Contact No. :        (Telephone): _____________________     (Fax): __________________________ Arrival Date: ____________________     Departure Date:______________________ Room Type ( Single/Double/Twin ): ________________________________________ Amount of Bank Draft : __________________________________________________ Date of Application : ______________________________ Flight/Arrival Time: _______________________________

** Note : Please send this form with your payment to the hotel of your interest directly before March 1, 1997.