For security reasons please fax this payment form to: CoopHotel +39 06 4452845
Credit Card Payment Form
participant's name:
affiliation:
mailing address:
city:
________________
postal code:
country:
telephone:
telefax:
e-mail:
arrival date (dd/mm/yy):
# adults
departure date (dd/mm/yy):
# children
special requests: ______________________________
Room Requested:
Deposit for hotel reservation ( equivalent to 1 night ) Euro
Please note that deposit is compulsory in order to allow reservation.
No cancellation fee if the cancellation is made before 48 hours of arrival
Reservations received after 15 April cannot be guaranteed (May is high season in Rome)
kind of accomodation requested (prices per room per night including breakfast)
__
hotel ( centrally located )
single room
Euro per night
-
hotel (centrally located)
single room
Eiro per night
-
hotel (peripherical area connected with centre )
single room
Euro per night
deposit for hotel reservation
Euro
__________________________________________________________________
Registration Fee after April 8
Student Registration Fee after April 8
450 Euro [ ]
350 Euro [ ]
Th e r e gi str ati on i n cl u de s b r ea k s, l u n ch e s, th e V ati can t ou r , an d th e ban qu e t.
Vatican Tour accompanying person 50 Euro / person
Banquet accompanying person
80 Euro/person
total amount to be paid:
Euro
VISA/Mastercard credit card number:
Tot:
Tot:
____________________
expiry date:
name on card (capital letters): ____________________________________________
Card Security Number: ________
cardholder signature:
__________________________________________________
Coophotels Roma - Via Santa Croce in Gersalemme 107- 00185 Rome, Italy
Tel. +39 06 4464763 - - Fax +39 06 4452845
e-mail: coophotel@tiscalinet.it
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