SURNAME: __________________________  

FIRST NAME: ________________  Mr / Mrs/ Ms: ________________

COMPANY NAME: _________________________________________________________________

ADDRESS: ______________________________________________________________________

CITY: ______________________________________________  POST CODE:_______________

COUNTRY:______________________

TELEPHONE:____________________

MOBILE:_______________________

FAX:__________________________

EMAIL:________________________

ROOM TYPE (please tick):   
                        
                        [] DELUXE ROOM     £150.00 + vat  [] JR. SUITE       £225.00 + vat
                        [] PARK SUITE      £325.00 + vat

DOUBLE OCCUPANCY ROOMS:  [] 1 BED    [] 2 BEDS

SMOKING:  [] YES      [] NO 		

CREDIT CARD DETAILS: [] VISA   [] MASTERCARD   [] AMEX   [] DINERS

CARD NUMBER: _____________________________________ EXPIRES: __________________

NAME ON CARD (please print):__________________________________________________

SIGNATURE OF CARD HOLDER: ____________________________________________________

EXPECTED TIME OF ARRIVAL: _______________________   DEPARTURE: _______________

If you require help with flights or airport transfers we are happy to
assist.


	

PAYMENT NOTES

• If you require your room to be billed to a credit card other than your own (and the cardholder will not be present) a THIRD PARTY AUTHORISATION form must be completed.

• Please let us know if you require one of these. Please also note the hotel will only accept American Express or Diners Club for Third Party Billing.

• Bank information for prepayment / wire transfers is also available by request.

• We have managed to obtain virtually exclusive use of the hotel for the period of the conference, and every available guest room has been reserved for registered delegates.
  As space is at a premium, accommodation requests have been linked to conference registration this year in order to safeguard this exclusivity, and final confirmation of reserved rooms will only be issued once your registration details have been processed by the ILMC office.