Hotel Reservation Form s4

Deep Drilling of the Amazon Continental Margin – IODP Workshop

“Cenozoic Climate and Biodiversity; Gravity Tectonics; Microbes, Diagenesis, Gas Hydrates and Fluid Flow”

March 24-26, 2014 - Buzios, Brazil

::: HOTEL BOOKING FORM :::

TO GUARANTEE YOUR HOTEL ACCOMODATION, PLEASE RETURN THIS FORM, BEFORE FEBRUARY 21, 2014.

(PLEASE USE PRINT LETTERS)

TITLE: FULL NAME:

AFFILIATION:

ADRESS:

POSTAL CODE: CITY: STATE: COUNTRY:

EMAIL:

PHONE: ( ) ( ) FAX: ( ) ( )

ACCOMMODATION

Please indicate your preference: / STANDARD / TAX
( ) SGL / ( ) DBL / ( ) TPL / ( ) QDP
( ) Hotel Atlântico Búzios / R$ 385 / R$ 470 / R$ 610 / R$ 750 / 5% + R$ 3

ALL PRICES ARE IN REAIS (BRAZILIAN CURRENCY*), PER ROOM, PER NIGHT, INCLUDING BREAKFAST

* EXCHANGE RATES: PLEASE CONSULT http://www.bcb.gov.br/?EXCHANGERATES

** TOURISM RATE: R$ 3 PER DAY

PAYMENT GUARANTEE RESERVATION:

ONE NIGHTS OF THE BOOKING PERIOD, NOT REIMBURSABLE

NAME(S) OF ACCOMPANYING PERSON(S):

1- 2-

3- 4 -

CHECK-IN : CHECK-OUT : NUMBER OF NIGHTS:

IF YOU HAVE A PHYSICAL DISABILITY, NOTE ANY SPECIAL ARRANGEMENTS REQUIRED:

CREDIT CARD DETAILS REQUIRED

I HEREBY AUTHORIZE THE HOTEL ATLÂNTICO BÚZIOS______TO CHARGE ONE NIGHTS OF THE BOOKING PERIOD PLUS TAXES TO GUARANTEE THE HOTEL RESERVATION BY THE FOLLOWING CREDIT CARD:

TYPE OF CARD: ( ) VISA ( ) MASTERCARD ( ) AMEX

CARD HOLDER’S NAME:

CREDIT CARD Nº: / EXPIRE DATE:
SECURITY CODE: / VISA AND MASTER: LAST 3 DIGITS ON THE BACK OF THE CARD.
AMEX: 4 DIGITS ON FRONT OF THE CARD

YOUR SIGNATURE: DATE / /2014

BY SIGNING I AGREE WITH THE TERMS AND CONDITIONS OF THIS FORM.

PLEASE RETURN THIS FORM INCLUDING THE PAYMENT INFORMATION TO THE SECRETARIAT:

Secretariat:

META MARKETING E EVENTOS

Av. Nilo Peçanha, 50 Grupo 1610 – Zip Code: 20020-906 – Rio de Janeiro - RJ - Brasil

Phone.: 21 2220-2097 - Fax: 21 2220-2305

E-mail: