FROM STARS TO GALAXIES: BUILDING THE PIECES TO BUILD UP THE UNIVERSE
VENICE, 16 – 20 OCTOBER 2006
Booking form for Travel/Accommodation/Social Activities
Please fill in this form in CAPITAL letters and send it back to:
MISSING ITALIA
Via Mazzini, 28 - 35028 Piove di Sacco – PD
Tel 0039 049 97 04 834 - Fax 0039 049 584 38 11
E-mail: galaxies@missingitalia.com
FAMILY NAME ……………………………………….FIRST NAME…………………………………………………….
INSTITUTION/COMPANY…………………………………………………………………………………………………
DEPARTMENT……………………………………………………………………………………………………………...
ADDRESS…………………………………………………………………………………………………………………..
CITY CODE ……………………………….CITY……………………………….COUNTRY……………………………
E-MAIL……………………………………………………….TEL…………………………..FAX………………………..
First name and family name of the ACCOMPANYING PERSON……………………………………………….
HOTEL RESERVATION
I hereby make a firm reservation
Date of arrival ……./……./………. Date of departure ……./……../……... N° of nights: ………….
I accept to share the room with someone else
HOTEL NAME
yes
TWIN SOLE USE ROOM
no
SINGLE ROOM
TWIN ROOM
AMOUNT
Prices are per room per night incl. breakfast, service charges and taxes. The number of nights booked serves as a basis for your hotel
invoice. Should the desired hotel no longer be available, we will provide alternative offer. Accommodation will only be guaranteed as soon
as the payment has been received by MISSING ITALIA.
SOCIAL ACTIVITIES
PROGRAMME
Secret itinerary
Venice,min.15
Lagoon Islands, min.
30 pax
Social dinner
Date/Time/Duration
Price(Euros)
October,18
26
October, 18
October, 19
30
50
No. Of People
Total
PAYMENT
 Bank transfer to: ANTONVENETA FILIALE DI PIOVE DI SACCO - CENTRO 258 VIA GARIBALDI, 64
COD.IBAN: IT 12 U050406274100000010920F
SWIFT: ANTBIT2P
 Credit Card
VISA
MASTER CARD
Credit Card number ……………………………..Expiry date ………………………………..CCV2……………………………….
Cardholder’s name ……………………………………………………………………..………………………………………………
DATE……………………………………………………SIGNATURE………………………………………………………………..
CONSENT TO USE PERSONAL DATA PURSUANT TO LAW 675/96
We inform you that the provision of your personal data is facultative, but failing to provide such information will result in your preclusion from reserve the above services. Personal
data shell be used in connection with or for the purpose of the fulfilment of the obligations arising from your attendance to the conference. The use of personal data is made by
means of manual or electronic processing, or in any case by computerized means, according to specific logics strictly linked to the purposes mentioned above so as to guarantee
utmost privacy and security of conveyed personal data. The user of personal data can avail itself of its affiliates or trustworthy third parties (hereinafter referred to as Third
Companies which, as autonomous
users of personal data, carry out technical or organization tasks, such as press office services, envelopes preparation,
transmission/transport/distribution of mailing to clients., data processing and IT consultancy. Your consent to the use of personal data also applies to the activity carried out by the
Third Companies, whose names can be obtained free of charge from the person in charge of the use of the personal data. Article 13 of Law 675/1996 acknowledges you specific
rights. In particular, you are entitled to request, at any time, information about which data have been conveyed and for which purposes. You may furthermore request that such data
be updated, integrated, modified or cancelled, withdraw your consent or deny the use of personal data. To be noted that the cancellation or withdraw concern data which are being
used in violation of legal provisions; for the integration a specific right must be granted. The instances, denial implies the existence of a legitimate motive. Instances pursuant to
Article 13 and the requests concerning the names of the third companies responsible for the use of personal data can be addressed to MISSINGITALIA., Via Mazzini, 28 Piove di
Sacco, 35028 PD (Italy).
MISSING ITALIA s.r.l.
Via Mazzini, 28 – 35028 Piove di Sacco (PD) – Italy - P. IVA 03955910280
Tel + 39 049 9704834 – Fax + 39 049 5843811
www.missingitalia.com