Sydney 2017 accomm booking form fillable

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.au

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).

Guest details

Please make your hotel selection Hotel options ________________________

First Name ___________________________

Surname _____________________________

Room type __________________________

Please add breakfast ___________________________

Company______________________________

Street Address _________________________

Check in date/time____________________

Suburb _______________________________

Departure date ______________________

Zip/Postal Code_________________________

I am sharing with ____________________

Country ______________________________

Mobile phone no _______________________

Email _________________________________

Payment: please select one card option - your card details will be provided to the hotel as security of your booking

MasterCard

VISA

American Express

Cardholder Name ______________________________________ Data is not secure

Card Number

Expiry Date

CVV

I authorise to allow my credit card to be used to secure my booking.