APL98 Reservation Form -------------------------------------------- Personal Information -------------------- Last Name: ________________________________________________________ First-Middle Name: ____________________________|___________________________ Title/Position: ________________________________________________________ Company/Organization: ________________________________________________________ Mailing Address-ZIP Code: ____________________________|___________________________ City-State-Country: _______________|_________________________|______________ Telephone-FAX: ____________________________|___________________________ e-mail: ________________________________________________________ Hotel Informations -------------------- Please, choose a hotel (prices are in Italian Lire x 1000) (1 US $ ± 1750 Italian Lire) Single DUS* Double Class Hotel (A) 80 100 120 *** Fiamma (B) 80 100 120 *** Siviglia (C) 80 100 120 *** Daniela (D) 80 100 120 *** Edera (E) 80 100 120 *** San Giusto (F) 100 120 140 **** Hermitage (G) 120 140 160 **** Pace Helvetia (H) 200 n.a. 250 **** Nazionale * Double used as single Fiamma Via Gaeta 61 Initial Availability: 30 DR - 10 SR Siviglia Via Gaeta 12 Initial Availability: 10 DR - 5 SR Daniela Via Luzzati 31 Initial Availability: 20 DR - 5 SR Edera Via Poliziano 75 Initial Availability: 20 DR - 5 SR San Giusto Piazza Bologna 58 Initial Availability: 20 DR - 10 SR Hermitage Via Vajna 12 Initial Availability: 20 DR - 5 SR Pace Helvetia Via 4 Novembre 104 Initial Availability: 10 DR - 5 SR Nazionale Piazza Montecitorio 131 Initial Availability: 20 DR - 5 SR Please mark a second choice (in case of unavailabilty of the first one): (A) (B) (C) (D) (E) (F) (G) (H) Car Parking: __YES __NO NOTE: Please note that this offer last till June, 10th. There is a limited room availability in this offer. The requests will be honored on a First-Come First-Served basis. In case of unavailability of the requested class, the requester will be contacted by APL98. Informations on stay -------------------- Date of arrival: __/__/__ Date of departure: __/__/__ # Total nights: __ Informations on rooms --------------------- # Single room(s): __ # Double room(s) used as single: __ # Double room(s): __ # Additional bed(s) (double rooms only): __ Payment Informations -------------------- Payment by credit card only. (Visa - AmericanExpress - MasterCard - EuroCard) For security reasons you shouldn't sent your credit card number by electronic means, but you should instead fax to the Conference Secretary the special form that you should fill at the end of registration process. ################### End of Registration Form ################### APL98 Credit Card Information Form -------------------------------------------- Last and First name (as appear on card): ________________________________________________________ Credit Card: __ VISA __ MASTER CARD __ AMERICAN EXPRESS __ EURO CARD Card Number: ________________________________________________________ Expiration date: ________________________________________________________ Signature (as appears on card): ________________________________________________________ ################################################################