Reservation Form for

La Quinta Inn and Suites
2015  S. Beulah Boulevard
 Tel: +1 928-556-8666 Fax: +1 928-214-9140

 

IⁿSITE 2005
Informing Science + IT Education Conference
June 16^th  – 19^th 2005

sponsored by
Northern Arizona University

 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: $70/night for all nights + TAX (about 11%)
[These discount conference rates are guaranteed only until April 30, 2004]

 

NUMBER OF NIGHTS: ________________ @ $70 per night =  _______________

 

  

Type of Beds:

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
La Qunita Inn & Suites Flagstaff
by 30^th April 2005
Fax number +1 928-214-9140