SEASREP 10Th Anniversary Conference

SEASREP 10th Anniversary Conference 8-9 December 2005 Chiang Mai, Thailand

HOTEL RESERVATION FORM

ATTENTION: Ms. Nongluk Chaithep Director of Sales Imperial Mae Ping Hotel, Chiang Mai E-mail: [email protected] Fax No.: 66-5327-0181

A. Personal Information Last Name First Name

Affiliation

Mailing Address

Tel. No. Fax No. E-mail

Dietary Requirements No preference Halal Vegetarian Other ______Credit Card Visa Master Amex Other ______Credit Card Number

Expiration Date (month/year)

B. Accommodation Details Date Time Airline Flight No. Arrival Date Time Airline Flight No. Departure Room Type Superior Single/Twin (Baht 1,800/night) Deluxe Single/Twin (Baht 2,200/night) Number of Nights Number of Rooms