<p> Reservation Form NH Hoteles</p><p>REFERENCE NAME : ECOLOGIC INSTITUTE/ WATER CONFERENCE REFERENCE BOOKING NUMBER : 175154872</p><p>Block dates : 23/05/2012 – 25/05/2012 Cut off date : 23/04/2012 O Mr O Mrs Last name: ______First name :______</p><p>Date of arrival: Date of departure: </p><p>Hotel Name: NH DU GRAND SABLON Rue Bodenbroek 2/4 1000 Brussels</p><p>Standard Room 23/05: O Single room € 150.00 per room, per night O Double room € 175.00 per room, per night Standard Room 24/05: O Single room € 130.00 per room, per night O Double room € 155.00 per room, per night</p><p>Breakfast is included. These rates are net and include services, taxes and VAT and are per night and per room. CANCELLATION FREE OF CHARGE UNTIL 5 DAYS PRIOR TO ARRIVAL PAYMENT METHOD O Payment by Guest We kindly ask you to guarantee the reservation by credit card in order to secure the room for you in case of late arrival. Any non-guaranteed rooms will be released at 4pm. Guarantee by credit card: O Visa O Mastercard O Diners Club O Eurocard O American Express Credit Card holder:______Credit Card Nbr :______Expiration Date :____/____ In case of no show the owner of the card authorizes the hotel to charge the credit card for the total stay. CONFIRMATION Please mention your email address or fax number should you wish to receive a confirmation of your reservation; email: ______fax number: ______</p><p>Please return this form to the reservation department: Brussels Booking Office Fax. + 32 2 518 1299 Tel. + 32 2 214 09 02 Reservation Form NH Hoteles</p><p>Please return the reservation form to [email protected]. The above rates are valid until 23/04/2012. After the above dates the rooms will be automatically released. And if guests would like to add rooms after this date, it will be subject to availability and the same price can’t be guaranteed anymore.</p><p>Please return this form to the reservation department: Brussels Booking Office Fax. + 32 2 518 1299 Tel. + 32 2 214 09 02</p>