WDAG'96 Hotel Reservation Form

Please print this form, fill it out clearly and then

FAX To:		Sig. Elio DELLAROSA (Hotel Paradise)

Fax: +39 51 234591
Tel: +39 51 231792


From:		___________________________________
Fax Number:		_____________________

Phone Number:		_____________________

Are you a student?  	[ ] No	      [ ] Yes

Hotel category:		[ ] 2-stars   [ ] 3-stars

Type of room:		[ ] Single    [ ] Double

Arrival date:		_____________________

Departure date:		_____________________

Credit Card type:	_____________________

Credit Card number:	_____________________

Expiration Date:	_____________________

Name on Card:		___________________________________


Signature: __________________________________