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					                                                  FLAMINGO HOTEL

                                        HOTEL ROOM BOOKING FORM

                         The 8th Asian Meeting on Electroceramics (AMEC-8)
                                                      (1 – 5 July 2012)
                                                     School of Physics
                                                  Universiti Sains Malaysia

Please complete this form in CAPITAL letters and send it by fax or email to the Reservation Department for related hotel


FAMILY NAME :                               FIRST NAME :                                  SALUTATION :


Please indicate the name of the person sharing the room:
NO. OF ADULT/S (INCLUDING YOURSELF):                               CHILDREN               :
AFFILIATION         :
ADDRESS             :


CITY                :                                            POST CODE :
COUNTRY             :                                            E-MAIL    :
PHONE               :                                            FAX       :




BOOKING INFORMATION

Check-in Date       :                                             Check-out Date      :

No. of night/s      :

Flight Number / ETA :                                             Flight Number / ETD:

Type of Room         :




Payment, Terms and conditions, please check with Hotel.

Signature :                                                       Date :

				
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