Hotel Reservation Form [PDF]

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HOTEL RESERVATION FORM Please type print in BLOCK LETTER and tick (√) where applicable



( ) Prof. ( First Name:



) Dr. (



) Mr.



(



) Mrs. ( ) Ms. Surname:



Institution: Address



:



City/ZIP Code: Sponsor:



Hotel The Ritz Carlton ( ) Grand ( ) Grand Business ( ) Grand Club ( ) Mayfair Suite JW Marriott ( ) Deluxe ( ) Executive Signature :



Phone:



Fax: Contact Person:



Room Rate



E-mail: Phone:



Check In



Check Out



Total Night



Rp. 1,800,000 Rp. 2,100,000 Rp. 2,600,000 Rp. 4,500,000 Rp. 1,700,000 Rp. 2,200,000



Payment should be made by Bank Transfer to: Acc. Name : ASMIHA Account No. : 117 – 00 – 0666566 - 5 Bank : Mandiri KCP Harapan Kita CANCELLATION AND REFUND POLICY  Written Cancellation of reservation must be notified to the 25th ASMIHA Secretariat before March 1, 2016  For name replacement, change of room type and notifying check in/out date prior to March 15, 2016, please contact the 25th ASMIHA secretariat.



Amount:



GROUP HOTEL BOOKING Group bookings (from 10 rooms) are handled separately and proposals are made upon request. Please contact us by email at [email protected] Or Fax: 021-5684220 INDIVIDUAL BOOKING PROCEDURE The individual hotel booking form can be downloaded from the ASMIHA website or is available upon request. Telephone request cannot be accepted.