<p> SEASREP 10th Anniversary Conference 8-9 December 2005 Chiang Mai, Thailand</p><p>HOTEL RESERVATION FORM</p><p>ATTENTION: Ms. Nongluk Chaithep Director of Sales Imperial Mae Ping Hotel, Chiang Mai E-mail: [email protected] Fax No.: 66-5327-0181 </p><p>A. Personal Information Last Name First Name</p><p>Affiliation</p><p>Mailing Address</p><p>Tel. No. Fax No. E-mail</p><p>Dietary Requirements No preference Halal Vegetarian Other ______Credit Card Visa Master Amex Other ______Credit Card Number</p><p>Expiration Date (month/year)</p><p>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</p>