| PERSON TO WHOM CONFIRMATION SHOULD BE
MAILED: |
| Family/Last/Given Name
_________________________________________________________ |
| First Name
___________________________________________________________________ |
| Organization___________________________________________________________________ |
| Address______________________________________________________________________ |
| ____________________________________________________________________________ |
| City
________________________________________________________________________ |
| State/Providence ______________________________________ Zip/Postal Code:
___________ |
| Country
_____________________________________________________________________ |
| Telephone _____________________________________ FAX
__________________________ |
| Email Address
________________________________________________________________ |
| INDICATE TYPE OF ROOM REQUESTED:
(check one) |
| ____ |
Single (1 bed, 1 person) |
____ |
Double (1 bed only, 2 people) |
| ____ |
Double/Double (2 beds, 2-4 people) |
____ Triple |
____
Quad |
| ____ |
Smoking |
____ |
Non Smoking |
____Require special facilities
in accordance with the American With Disabilities Act
(Please attach description) |
|
| Arrival Date______________ Arrival Time
________________Departure Date _______________ |
| TYPE OF CARD: Reservation
will not be processed without a form of guarantee. |
| ___American Express |
___Diner’s Club |
___ VISA |
___ Discover |
___ Master Card |
|
| Account #
_________________________________________Exp.Date____________________ |
| Printed Name
__________________________________________________________________ |
| Signature______________________________________________________________________ |
| ____ Check [must accompany form in the amount of $175 per room (payable
to SJCVB) |
FAXed forms will not be accepted without credit card information.
No purchase orders will be accepted.]