Accommodation Request Form - Rotary Institute Zone 7A&8A 2005

Accommodation - Request Form

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Venue and Accommodation Type

Holiday Inn		Nepean Shores
Single	Double	1 Room Cottage
Smoking	Non-Smoking	2 Room Cottage

Dates

Date of Arrival

Date of Departure

Names of Occupants

Surname	First Name

Payment Details

A deposit of $125 is required for all reservations made on your behalf. In the event of cancellation before 18 September 2005, this deposit will be refundable in full. Thereafter a refund will be made only if the room is re-let.

I enclose a cheque payable to “Rotary Institute” for $125

Please charge my credit card with the sum of $125
Type (Not Amex or Diners Club) Visa Mastercard Bankcard
Card Number		Expiry Date mm/yy
Name on Card
Signature		Dated

Please print, sign and send your completed form to PDG Judith Ward, 1a Bay Street, Birchgrove, NSW 2041, FAX (02) 98188768.