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 |
___Diners 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.]