Budget Hotel in Bangkok by Chad_Cataman

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									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
Deluxe room, double occupancy with breakfast          US$ 140 /night
Petite Suite, with breakfast                          US$ 180 /night
Junior Suite, with breakfast                          US$ 230 /night


      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)

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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        US$ 35 /night
Double room with breakfast        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        US$ 40 /night
Double room with breakfast        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                  US$ 40 /night
Double room with breakfast                  US$ 45 /night

           7.     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                  US$ 30 /night
Double room with breakfast                  US$ 35 /night

           8. Pradipat Hotel

      #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                  US$ 30 /night
Double room with breakfast                  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                 50 meters from rooms                2 – 3 minutes            walk
    2. Chao Phaya Park                       1 Kilometer                         10 – 15 minutes          subway, taxi
    3. The Travellers                        1 Kilometer                         10 – 15 minutes          subway, taxi
    4. Liberty Garden                        3.0 Kilometers                      10 – 12 minutes          public bus, taxi
    5. Pradipat                              3.25 Kilometers                     10 – 12 minutes          public bus, taxi
    6. Elizabeth                             3.5 Kilometers                      10 – 12 minutes          public bus, taxi
    7. Karmanee Palace                       4 Kilometers                        10 – 15 minutes          public bus, taxi
    8. Siam City                             7 Kilometers                        30 – 40 minutes          shuttle bus*, taxi
    9. Student hostels                       8 kilometers                        30 – 40 minutes          public bus, taxi
    (* door-to-door shuttle buses will provide morning 7.30 AM service during the congress)
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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 no-
shows.

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 e-
mail 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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