ESITO 2001 ACCOMMODATION FORM

To be sent to Residence Hotel Cormoran

First name_______________________________________________________________

Family name_____________________________________________________________

Title____________________________________________________________________

Affiliation________________________________________________________________

Address ________________________________________________________________

Zip Code __________ City________________ State _______ Country _______________

Tel __________________ Fax _________________ e.mail________________________

First name and family name of the accompanying person(s)

_______________________________________________________________________

_______________________________________________________________________

will share the room with

_______________________________________________________________________

_______________________________________________________________________

I request accommodation as follows:

Single room ___________ Double room ____________ other ________________

Arrival ____________________ departure __________________

I enclose ITL 300.000 per person as down payment to Residence Hotel Cormoran:

Check Data (non-negotiable check)___________________________________________

Credit Card: Visa ____ American Express _____ Eurocard ______ Mastercard ______

Name on the credit card ___________________________________________________

Credit card number______________________________

Expiration date __________ Cardholder’s signature _______________ Date___________

Bank transfer ________ headed to Residence Hotel Cormoran, Cassa di Risparmio di Asti Ag. No 2

ABI Code: 6085.5 CAB Code: 10302.8 CIN Code: L

I make reservation for bus transportation from Elmas Airport to Residence Hotel Cormoran:

Arrival date ____________ Time ________ Flight No _______________________

I will ___________ I will not________ participate in the boat excursion

_______________________________________________________________________

Residence Hotel Cormoran, Località Campus, 09049 Villasimius-CA, Sardegna, Italy

Tel: 0039 070798101 Fax: 0039 070798131 e.mail: [email protected]

http://www.hotel-cormoran.com