41st EIBA Annual Conference R i o de J a n e i r o December 1 - 3, 2015 Reservation will considered filling out this Booking Form and send it with a copy of front & verse to [email protected] Name: ___________________________________________________________________________________________ Accompanying name: ______________________________________________________________________________ E-mail: ________________________________ Phone # ( ) __________________ Mobile: ( ) _______________ DAILY RATE IN REAIS BRL PRICES PER ROOM / PER DAY HOTEL Distance to the Conference Site Pestana Rio Atlantica ***** 2 km TYPE OF ROOM SINGLE DOUBLE Standard R$ 490,00 R$ 530,00 TAXES 15% Hotel accommodation Arrival date : _____/_____ Departure date : _____ / ______ Type of room ( ) Single ( ) Double ( ) Twin PAYMENT & CANCELATION POLICIES: • Daily rate in BRL Reais. • Reservations will be considered filling out this Hotel Registration Form and send it back to [email protected] • Upon request, Everest Hotel will charge the total room nights plus taxes • Incidentals expenses have to be paid directly to the hotel upon check out • Check in time: 02:00 pm and check out at 12:00 noon • Rates are valid 3 days prior and 3 days after the period of the Event • The reservation can be cancel without penalty until November 1st , 2015. METHOD OF PAYMENT: CREDIT CARD Card Holder Name ( ) VISA ( ) MASTERCARD ( ) AMEX : __________________________________________________________________________________ Number of the card : ________________________________________________ Security code Expiration..: _______/______ : __________________* 3 or 4 last numbers in the verse of the card _____________________________________________________________ _____/_____/_____ Signature Date Signing this document I agree with all the payment and cancellation policies included in this form. Follow Up Turismo & Eventos – Official Travel Agency Rua Francisco Sá, 23 sala 1106 – Copacabana – Rio de Janeiro – RJ Tel: + 55 21 3005-2310 extension numbers 642 or 643 Emergency phone + 55 21 98234-0001 Email [email protected]