Conference and Hospitality Services
Laurentian Chapter of the Society of Environmental Toxicology and Chemistry
Accommodation Booking Form
Contact Information:
Your Name:
Day-time Telephone #
Email Address:
Mailing Address:
City:
Street:
Prov/State:
Country:
Postal/ZIP Code:
Accommodation must be booked by May 21st, 2012 to Guarantee these rates
Accommodation Includes: Single Occupancy rooms (one double bed) and breakfast.
Gzowski College: Rate $70.00 + 13% tax = $79.10 per night
Select applicable nights:
Nightly rate
June 20th
June 21st
$ 79.10 x # of nights
June 22nd
=$
* Deadline for Cancellation and Full Refund – June 10th, 2012
* Cancellations after June 10th, 2012 subject to one night accommodation charge
* No Refunds for early departures or no shows
Dietary Restrictions:
If submitting electronically please call to provide credit card information directly
Payment Details:
Name on Card
Cardholder’s Address
Card Number
Select Payment Type: Visa
MasterCard
Institutional Cheque
Money Order
Cardholder’s Signature
Expiry Date
Amount of Payment $
(Make Cheques payable to Trent University Conferences Services)
Contact Information:
Toll Free:
Phone #:
Fax #:
Email:
Bank Draft
1-866-290-6491
705-748-1260
705-748-1209
conferences@trentu.ca
Preferred method for receiving a receipt:
By Mail
or
Submit
-1-
by Email