Please print out this form and fax it to the Housing Bureau.
Fax: 514 844 6771
Indicate Hotel Preference:
First Choice: __________________________________
Second Choice: __________________________________
Third Choice: __________________________________
Indicate Type of Room Requested:
[ ] Single
[ ] Double
[ ] Other: __________________________________
Any special requirements? Wheelchair accessible, etc. [ ] Yes.
Please Describe: __________________________________
Arrival Date: __________________________________
Arrival Time: __________________________________
Departure Date: __________________________________
Guarantee late arrival? [ ] Yes [ ] No
Guarantee to:
[ ] American Express
[ ] VISA
[ ] MasterCard
[ ] Diner's Club
[ ] Discover
Credit Card Number: __________________________________
Expiration Date: __________________________________
Signature: __________________________________
Name of Occupants(s) [Bracket names sharing rooms]
__________________________________
Person to whom confirmation should be mailed:
Name: __________________________________
Affiliation: __________________________________
Address: __________________________________
City, State/Province__________________________________
Postal Code __________________________________
Country __________________________________
Telephone Number __________________________________
Fax Number __________________________________
Hotel/Housing Reservation Request Must be Received by May 17, 1996