Hotel Reservation Form
CMU FON Interprofessional Partnership Conference - 5-7 September 2012
1. Personal information :
Name:__________________________________ Last name _______________________________
Contact Address: __________________________________________________________________
E-mail Address:_______________________________Telephone:___________________________
2. Reservation:
2.1.1 The Empress Hotel Chiang Mai
Superior  1,300 (Single/Twin)/Night/Room  600 Extra Bed
Deluxe  1,800 (Single/Twin)/Night/Room  600 Extra Bed
2.1.2 The Park Hotel Chiang Mai
Superior  1,000 (Single)/Night/Room  500 Extra Bed
Deluxe  1,400 (Single)/Night/Room  500 Extra Bed
Shuttle bus between The Park Hotel and The Empress Hotel are available free of charge
Check-In Date: ___________________________ Check-Out Date: _______________________________
Arriving By: _____________________ Flight No. __________________ Time _____________________
Airport pick up 90 THB/person number of passenger ______________________________
3. Settlement: by Cash Visa Card Master Card
Card holder name________________________________________________________________________
Credit Card No. ________________________________________ Exp. Date: _______________________
Special Request: _________________________________________________________________________
4. Reservation Condition :
4.1
4.2
4.3
4.4
4.5
Reservation will be accepted only until August 10, 2012. After this date reservation will be subjected to room availability
Reservation must be guaranteed with Credit Card or Cash.
No Show or Late arrival will be charged as per reservation.
Cancellation made after August.25 2012, will be charged for the whole period of reservation.
Please kindly fax or email this form back to the hotel.
Reservation at The Empress Hotel, Chiang Mai
Reservation at The Park Hotel, Chiang Mai
Tel : 66 53 253 199 Fax : 66 53 279 956
Tel: 66-53-280 080 Fax 66-53- 279 979
E-mail : rsvn@empresshotels.com
E-mail: rsvnpark@empresshotels.com
Website: www.empresshotels.com
Website: www.empresshotels.com
For hotel use only Confirmed By__________________________
Date_________________