Accommodation Booking Form
Conference Name: SPA 2017 National Conference
Conference Dates: 28 - 31 May 2017
Conference Location: Sydney
To secure and confirm your accommodation, credit card details are required at time of booking.
One night’s deposit (unless otherwise specified payment conditions) will be debited from the
card that is provided to the hotel/apartment. A confirmation will be provided by PR Conference
Consultants and the Tax Receipt will come from the hotel/apartment. An imprint of your credit card
will be required upon check in and your account is to be settled with the hotel/apartment upon
departure (unless otherwise specified payment conditions).
PR Conference Consultants
PO Box 502
Kilmore Vic 3764
Australia
Phone: 61 3 5781 0069
Fax: 61 3 5781 0082
www.speechpathologyaustralia.org.au pam@prcc.com.auGuest details
Please make your hotel selection
First Name ___________________________
Surname _____________________________
Company______________________________
Street Address _________________________
Suburb _______________________________
Zip/Postal Code_________________________
Country ______________________________
Mobile phone no _______________________
Email _________________________________
Hotel options ________________________
Room type __________________________
Please add
breakfast ___________________________
Check in date/time____________________
Departure date ______________________
I am sharing with ____________________
Payment: please select one card option - your card details will be provided to the hotel as security of your booking
Cardholder Name ______________________________________
Data is not secure
Card Number
Expiry Date
CVV
American Express
MasterCard
VISA
I authorise to allow my credit card to be used to secure my booking.