5 TH ANNUAL ISNVD Scientific Meeting March 27 – 29 , 2015 HOTEL ACCOMODATION FORM PARTICIPANT ________________________________________________________________________________ Family Name First Name Please fill in ( complete in block capitals) and return to: MP s.r.l. Congressi e Comunicazione Via Coroglio, 57/D – 80124 Napoli Ph. +39 081 5753432 - +39 081 2466459 fax +39 081 5750145 e-mail: [email protected] – web site : www.mpcongress.it ________________________________________________________________________________ Address ________________________________________________________________________________ Post Code City Country ________________________________________________________________________________ Mobile Ph./Fax. ________________________________________________________________________________ e-mail ________________________________________________________________________________ Fiscal Code o VAT Num. Date of birth Place of birth ACCOMPANYING PERSON ________________________________________________________________________________ Family Name First Name HOTEL RESERVATION (to be filled in and sent within December 10th 2014) Selected Hotel Single Room Double Room Hotel *****L deluxe € 230,00 € 260,00 € 220,00 € 250,00 € 149,00 € 169,00 € 155,00 € 180,00 ( HOTEL VESUVIO) Hotel ****S deluxe ( HOTEL EXCELSIOR) Hotel **** superior vista mare ( HOTEL ROYAL) Hotel **** (HOTEL S. LUCIA ) ________ _ ARRIVAL DATE _____________ DEPARTURE DATE ________ FEE AGENCY € 20,00 Total amount €…………………………………. N° of nights * (Price is per room per night including breakfast. To be added tourist tax € 2,50 per person per night payable locally) RULES 'OF RESERVATION: This booking form must be sent to MP Congressi duly completed and accompanied by a copy of the bank transfer or credit card for the total amount your stay . Reservation and payment must be made: Hotel Royal by 25 October St. Lucia Hotels by 6 November Hotel Excelsior / Hotel Vesuvio by December 1 Will not be taken into account the reservations did not have the details of the payment. Booking is subject to availability and will be confirmed by the MP srl Conferences and Communication, each participant will receive confirmation of your reservation with the hotel name and address. PAYMENTS ALL PAYMENTS MUST BE MADE IN EURO AND ADDRESSED TO MP S.R.L. AND MARKED WITH THE CODE “5th Annual ISNVD + name and surname of the registered person” Credit Card / Please charge the sum of Euro _______________ + transit commission bank € 9,00 from Visa Master Card Carta Si Card Number n._ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Expiration Date / / Number of security __ __ __ * Corresponds to the last 3 digits of the identification number on the back of the card Cardholder_______________________________________________________________________ Signature___________________________ Date ________________________________________ Bank Transfer / (net of bank charges) Euro ___________________________________ Account holder: “MP srl Congressi e Comunicazione” Bank: Banca della Campania Ag. 1 – Napoli Account n. 211837 Abi code: 05392 Cab code : 03401 Cin T IBAN code : IT28T0539203401000000211837 – SWIFT code: BPMOITC1 Certification of payment made by bank transfer m ust be mailed or fax ed w ith the registration form . INVOICING (please fill only in case invoice should be named and addressed to another subject) Family Name ___________________________ First Name _____________________________ Address________________________________________________________________________ City ____________________________ Country ________________________Post Code_______ Fiscal Code o VAT Num. ___________________________________________________________ Date___________________________ Signature ________________________________________ In accordance with Legislative Decree 196/03 I authorize the use of data provided for the purpose of receiving information and notices.