Reservation Form for
AmeriSuites
Flagstaff Interstate Crossroads
2455
S. Beulah Boulevard
Tel: +1
928-774-8042 Fax: +1
928-774-5524
Conference organized by the Informing Science
Institute
Eli Cohen and Elizabeth Boyd, Organizers@InSITE.nu
NAME of Delegate:_____________________________________________________________
ADDRESS:______________________________________________________________________
______________________________________________________________________________
Country
__________________________________________ POSTAL CODE: ________________
TELEPHONE: _______________________ FAX:___________________________
EMAIL: ___________________________________________________________
Names of others sharing room (if any) ________________________________________________
DATE of
ARRIVAL: _____________ DATE of DEPARTURE: ________________
Room Rate:
$69/night for all
nights + TAX (about 11%) Third and fourth adult in the same suite, $10
each.
[These
discount conference rates are guaranteed only until
NUMBER OF NIGHTS: ________________ @ $69 per night = _______________
NUMBER OF Additional Adults: ________@ $10 per night = ______________
Two Beds r One Large Bed r
Payment
details:
(Please circle) Money
order Credit Card
CREDIT CARD NUMBER:
____________________________________________
Expiration Date of Card (MM/YY) ______ Name of card holder ________________________
_____________________________________________________________________________
Signature of card holder Date
Should I need to change my
plans, I will notify the
hotel the day before I am scheduled to arrive. Otherwise the hotel will hold my
room for my arrival and charge my credit card for that night.
Please fax
completed form to
AmeriSuites
Flagstaff
by 30th April 2005
Fax number +1 928-774-5524