TIWDC_2007
   

ACCOMMODATION FORM

RESERVATION DEADLINE IS JULY 15, 2007
After this date reservations will be handled on a space-available basis.

Please, type in block letters and press the "SEND" button. In the next page you will find a pushbutton to print this form. Return the printed form  by fax to the Organizing Secretariat.

 

D.G.M.P. s.r.l.
Via A. Gozzini, 4
56121 Ospedaletto PISA (ITALY) 
Tel: + 39 050 989.310
Fax: + 39 050 981.264
E-mail: info@dgmp.it


PERSONAL DATA


       
Title:  
 
Last name: First name:
 
Affiliation: Address:
 
City: Zip code:
 
Country: E-mail:
 
Phone: Fax:

 

* All prices are in Euro;
* The prices quoted cover bed and breakfast, services and taxes;
* All rooms have a private bathroom;
* Participants will receive a voucher for their hotel reservation;


HOTEL

 

Category
Hotel
Double for Single Use
Double
Hotel Continental Terme
120,00
145,00
Hotel Annabelle
95,00
130,00

Those who wish to arrive before 9 th Sept. and/or leave after 12 th Sept. are kindly requested to specify it below. As soon as the hotel confirms the availability the Organizing Secretariat will send the voucher for hotel confirmation.

 

Hotel:  

                   (dd/mm/yyyy)
Arrival Date:

Total number of Nights:

Room Kind: rate:

(dd/mm/yyyy)          
Depar. Date:

Total Rooms:

 

If you are sharing the room with another registered delegate please write down the name below:

 

Special Requirements:
 Remaining Chars

PAYMENT


As payment of the above mentioned reservation for the total amount of:  Euro


PAYMENT BY CREDIT CARD  

VISA - MASTERCARD  (on-line  payment) - You will submit Credit Card data under SSL support security of our Bank.

 

VISA - MASTERCARD (off-line  payment) filling the following fields with your Credit Card data    

DINERS (off-line  payment) filling the following fields with your Credit Card data

Credit card n°

Expiration date: (mm/yyyy) 

Print name as it appears on card 

 

I authorize to charge my credit card for the total amount.

Electronic credit cards will be accepted for on site payments only

On your credit card statement of account the description of this payment will be D.G.M.P. srl

PAYMENT BY BANK DRAFT:

Bank : Cassa Risparmio di Lucca Pisa Livorno
Bank Address : Corso Italia, 4 – 56125 PISA
Account number :2752-2549/66 ABI : 6200 CAB : 14021 CIN:D
IBAN : IT 05 D 06200 14021 000000254966 Swift code : BPALIT3L


Please note that the bank draft must be free of charge for recipient.

A copy of the bank transfer must be sent by fax to +39 050 981264 along with the accomodation form.

 

CANCELLATIONS: Written cancellations received before 9 August 2007 will be entitled to a full refund minus € 50,00 charge. After this date until 25 August only a 50% refund minus bank charges will be acknowledged. No refund is foreseen after 25 August.
Refund will take approximately eight to ten weeks. Delegates not showing at the hotel will have their reservation cancelled by default and will not be eligible to receive any refund.


Please note that all your personal information is encrypted
using a secure protocol (SSL) to ensure maximum privacy.