Hotel Reservation Form
9th International Congress of Behavioral Medicine, November 29 – December 2, 2006, Sofitel Central Plaza Hotel, Bangkok, Thailand Welcome to on-line/off-line hotel reservation.
Please fill in all necessary information before submitting on-line or send the off-line hotel reservation form back to the 9icbm-2006 Congress Secretariat By email at tennc@mahidol.ac.th or fax at +662-4419743 Fields marked with * are required! Registration ID# * ٱٱٱٱ (For on-line process, you must register on-line for the 9icbm and obtain your ID# before you make a hotel reservation here) Name and Address (Please use the same name as in your ID card or Passport, and exactly the same as the name you use for submitting abstracts). (For on-line hotel reservation, the data fields will be retrieved from registration database after you fill-in Registration ID#) 1. Your First Name: * …………………………. 2. Your Middle Initial (If any): …………………………. 3. Your Surname (Last name): * …………………………. 4. Title: * ( Prof.,
Dr., Mr., Mrs., Ms., other specify ………………..)
5. Mailing address: * …………………………………………………………………….. ……………………………………………………………………………………………… ……………………………………………………………………………………………… 6. City: * …………………………………….. 7. State or Province; * …………………….. 8. Zip Code: * ……………………………… 9. Country: * ………………………………… 10. Telephone: * (Country code - city code - number) ……………………………….. 11. Fax: (Country code – city code – number) …………………………………………. 12. Email address: * …………………………………….. (Your confirmation will be e-mailed to the address listed above – please print clearly and correctly)
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13. Gender:
Male female
14. This above address is *
Official or business or Home or residential
15. Name and Gender of Spouse or accompanying person(s) who shares your hotel room. ………………………………………………………………………………… Number of person(s) ………………………………….. Number of room(s) …………………………………….. Type of room ……………………………………………
Non-smoking Smoking Other requirements ………………………………………………………………
16. Check-in date …………….. Approximate time ………………………………. 17. Check-out date ……………. Approximate time ………………………………
Hotel Selection (Name of hotels listed by descending classes of hotel)
1. Sofitel Central Plaza Hotel (9th ICBM Congress site) The 9th International congress of Behavioral Medicine will be held at the Sofitel Central Plaza Bangkok Hotel, 1695 Phaholyothin Road, Chatuchak, Bangkok 10900 (for further information please visits the hotel and congress website at http://www.centralhotelsresorts.com). Please make your reservation before June 15, 2006 to secure your room and receive confirmation. After June 15, 2006 the confirmation can only be made on room availability. A five star class hotel and adjoining central department store and a public park
Deluxe room, single occupancy with breakfast
US$ 130 /night US$ 140 /night US$ 180 /night US$ 230 /night
Deluxe room, double occupancy with breakfast Petite Suite, with breakfast Junior Suite, with breakfast
2. Siam City Hotel
477 Sri Ayuthaya Road, Phayathai, Bangkok 10400, an exotic and classical four star class hotel in the center of the Bangkok city with full facilities and high-speed internet service, 7 kilometers from congress venue, 25 minutes to the Congress venue by monorail sky-train. 30 to 40 minutes by taxi or hotel limousine during peak hours. There will be an operation of door-to-door shuttle bus service during the congress. One block or one sky-train stop from major shopping complexes at Siam Discovery and Siam Paragon, Siam Square, Mahboonkrong centers. (For further information please visits the hotel and congress website at http://www.siamhotels.com) 2
Superior room, single occupancy with breakfast US$ 75 /night Superior room, double occupancy with breakfast US$ 85 /night Deluxe room, single occupancy with breakfast US$ 95 /night Deluxe room, double occupancy with breakfast US$ 105 /night Deluxe-Business, single occupancy with breakfast US$ 100 /night Deluxe-Business, double occupancy with breakfast US$ 110 /night Executive Suite, single occupancy with breakfast US$ 155 /night Executive Suite, double occupancy with breakfast US$ 165 /night
3. Chaophya Park Hotel
247 Rachadapisek road, Dindaeng, Bangkok 10400, a block or 1 kilometer away, 10 to 15 minute to the Congress venue by underground subway system or taxi, a nice and friendly four stars class hotel with full facilities and high-speed internet service (For further information please visits the hotel and congress website at http://www.chaophyapark.com)
Superior room, single occupancy with breakfast US$ 60 /night Superior room, double occupancy with breakfast US$ 65 /night Deluxe room, single occupancy with breakfast US$ 80 /night Deluxe room, double occupancy with breakfast US$ 85 /night Deluxe-Business, single occupancy with breakfast US$ 90 /night Deluxe-Business, double occupancy with breakfast US$ 95 /night Executive room, single occupancy with breakfast US$ 125 /night Executive room, double occupancy with breakfast US$ 130 /night
4. The Travellers Hotel 255/19 Rachadapisek road, Dindaeng, Bangkok 10400. A budget class small hotel with coffee shop, restaurant and internet service located a block or 1 kilometer away, 10 to 15 minute to the Congress venue by underground subway system or taxi. (For further information please visits the hotel and congress website at http://www.travellers-hotel.com).
Single room with breakfast Double room with breakfast
US$ 35 /night US$ 40 /night
5. Karnmanee Palace Hotel #1 Pradipat Road, Phayathai district, Bangkok 10400. A two star Thai Hotel with full facilities and internet service located 4 Kilometers from the Congress venue, and 10 – 15 minute by city bus or taxi to the congress venue. (For further information please visits the hotel and congress website at http://www.karnmanee.com).
Single room with breakfast Double room with breakfast
US$ 40 /night US$ 45 /night
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6.
Elizabeth Hotel
#169/51 Pradipat Road, Sapan Kwai Area, Phayathai district, Bangkok 10400. A two star Thai Hotel with full facilities and internet service located 3.5 Kilometers from the Congress venue, and 10 – 12 minute by city bus or taxi to the congress venue.
Single room with breakfast Double room with breakfast
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US$ 40 /night US$ 45 /night
Liberty Garden Hotel
#215 Pradipat Road, Sapan Kwai Area, Phayathai district, Bangkok 10400. A small Thai Hotel with restaurant and internet located 3.0 Kilometers from the Congress venue, and 10 – 12 minute by city bus or taxi to the congress venue.
Single room with breakfast Double room with breakfast
8. Pradipat Hotel
US$ 30 /night US$ 35 /night
#173/1 Pradipat Road, Sapan Kwai Area, Phayathai district, Bangkok 10400. A small Thai Hotel with restaurant and internet located 3.25 Kilometers from the Congress venue, and 10 – 12 minute by city bus or taxi to the congress venue.
Single room with breakfast Double room with breakfast
US$ 30 /night US$ 35 /night
9. Student hostels and serviced apartment in Phaya Thai area Clean and air-conditioned room with private or shared bath in student hostels or serviced apartment in Phaya Thai area, 8 Kilometers from the Congress venue, and 30 – 40 minute by city bus or taxi to the congress venue.
Air-conditioned single room with private bath US$ 25 /night
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Summary Table of hotels for selection by distance from congress site
Distance from Congress Time to congress Means of Transport
1. Sofitel Central Plaza 2. Chao Phaya Park 3. The Travellers 4. Liberty Garden 5. Pradipat 6. Elizabeth 7. Karmanee Palace 8. Siam City 9. Student hostels
50 meters from rooms 1 Kilometer 1 Kilometer 3.0 Kilometers 3.25 Kilometers 3.5 Kilometers 4 Kilometers 7 Kilometers 8 kilometers
2 – 3 minutes 10 – 15 minutes 10 – 15 minutes 10 – 12 minutes 10 – 12 minutes 10 – 12 minutes 10 – 15 minutes 30 – 40 minutes 30 – 40 minutes
walk subway, taxi subway, taxi public bus, taxi public bus, taxi public bus, taxi public bus, taxi shuttle bus*, taxi public bus, taxi
(* door-to-door shuttle buses will provide morning 7.30 AM service during the congress) 4
Hotel Map
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Reservation and Cancellation Policy
Reservation is on first comes first serves, and depends on room availability. An equivalent of one-night room-charge non-refundable deposit will be charged to you on confirmation of availability of hotel reservation. No refund for this deposit will be made for noshows. The remaining night room-charges plus other extra service charges will be paid to the hotel on check-out.
Summary
Name of Hotel selected *………………………………………….. Number of person(s) *………………………………….. Number of room(s) *…………………………………….. Type of room *……………………………………………
Non-smoking Smoking Other requirements ………………………………………………………………
Check-in date *…………….. Approximate time *………………………………. Check-out date* ……………. Approximate time * ……………………………… Amount deposit USD* …………………………………….
Payment for hotel reservation *
Please pay an equivalent of one-night room-charge non-refundable deposit at the time of reservation. Please remember to include the name of the participant on the money transfer and send us a copy of the transfer document by email and fax. You may choose to pay by one of the following ways:
ٱBank Transfer by SWIFT Transfer to: (Most recommended)
Account Name: 9icbm2006 Account Number: 333-2-19223-8 Swift Code: SICOTHBK BANK: The Siam Commercial Bank Public Company Limited Branch: Mahidol University Sub-branch (Salaya)
ٱBank Draft payable to:
Account Name: 9icbm2006 Account Number: 333-2-19223-8 BANK: The Siam Commercial Bank Public Company Limited Branch: Mahidol University Sub-branch (Salaya)
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ٱCredit Card ( ٱOn-line or ٱOff-line) : Please charge my: ٱVISA ٱMaster Card Card Verifying Code: ( ٱٱٱthe three last digits on the signature side)
Card Holder Name (As appeared on the Card) _______________________ Card Number: ٱٱٱٱ ٱٱٱٱ ٱٱٱٱ ٱٱٱٱ Name of Card Holder (As appeared on the card) _______________________ Valid through (Expired Date month/year) ____/_____ The total sum of US$ _________ (In words: ______________________________) Date: ________________ Card Holder’s Signature: ____________________________________ Return the Hotel Reservation Form by email to: icbm2006@mahidol.ac.th and also send signed Hotel Reservation Form by FAX to: + (662)-4419743 or send us a scan JPG file to tennc@mahidol.ac.th
Confirmation
For on-line hotel reservation, you will receive an immediate automatic reply and a Reservation ID# XXXX For off-line registration, you will receive a reply by email. If you do not receive a confirmation email within two weeks of registering, please email or contact the congress secretariat by email at tennc@mahidol.ac.th to verify that we received your registration form. Hotel reservation will be completed and you will receive final confirmation only when we have received your deposit payment transfer to the 9icbm2006 account.
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