Breast Cancer in Young Women Conference - OECI
Breast Cancer in Young Women Conference - OECI
Breast Cancer in Young Women Conference - OECI
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ACCOMMODATION FORM<br />
BCY1 - BREAST CANCER IN YOUNG WOMEN CONFERENCE - 8-10 November 2012, Dubl<strong>in</strong>, Ireland<br />
Please fill <strong>in</strong> this form us<strong>in</strong>g BLOCK Capitals and send to Leah Perrot at MCI Dubl<strong>in</strong> by email or fax to<br />
esodubl<strong>in</strong>@mci-group.com - Fax +353 1 2805405<br />
MCI Dubl<strong>in</strong> - 1 Clar<strong>in</strong>da North, Dun Laoghaire, Co.Dubl<strong>in</strong>, Ireland - Tel +353 1 2802641<br />
For onl<strong>in</strong>e accommodation book<strong>in</strong>g and for more <strong>in</strong>formation on the hotels please go to www.eso.net<br />
PARTICIPANT INFORMATION<br />
Dr. Prof. Mr. Ms.<br />
First name<br />
Organisation<br />
Address<br />
City<br />
State/County<br />
Tel<br />
(<strong>in</strong>clud<strong>in</strong>g country code)<br />
Surname<br />
Postcode/Zipcode<br />
Country<br />
Fax<br />
(<strong>in</strong>clud<strong>in</strong>g country code)<br />
BOOKING<br />
All rates are quoted <strong>in</strong> Euro, per night <strong>in</strong>clud<strong>in</strong>g breakfast and VAT.<br />
Please choose your hotel below<br />
S<strong>in</strong>gle room Double room Tw<strong>in</strong> room<br />
Stillorgan Park Hotel ( ) EUR 99 EUR 109 EUR 109<br />
Ballsbridge Inn ( ) EUR 75 EUR 90 EUR 90<br />
D4 Berkeley ( ) EUR 100 EUR 115 EUR 115<br />
Check <strong>in</strong> date<br />
Check out date<br />
Shar<strong>in</strong>g with<br />
TERMS AND CONDITONS<br />
Please see the onl<strong>in</strong>e book<strong>in</strong>g system on www.eso.net<br />
CREDIT CARD DETAILS<br />
Accommodation payment and extras will be paid directly to the hotel. Please provide your credit<br />
card details <strong>in</strong> order to guarantee your book<strong>in</strong>g. With out card details it will not be possible to<br />
make a book<strong>in</strong>g.<br />
CREDIT CARD: Mastercard or Visa only<br />
Credit card number / / / Expiry date /<br />
Card holders name (<strong>in</strong> Capital letters)<br />
CVV number<br />
Card holders signature<br />
I agree to the terms and conditions and that my credit card details will be forwarded to the appropriate<br />
hotel to guarantee my book<strong>in</strong>g.<br />
Signature<br />
If you require any assistance with your book<strong>in</strong>g please do not hesitate to contact Leah Perrott at:<br />
esodubl<strong>in</strong>@mci-group.com - Tel: +353 1 2802641
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