3rd SAFE Workshop 2nd Announcement - APRSAF

HOTEL RESERVATION FORMAppendix CThe 3rd SAFE Workshop in Vientiane, Lao PDRPlease send this form to the Lao Plaza Hotel no later than 20 May 2011.If you send this form after 20 May, your reservation will be confirmed depend on vacancy of the hotelLao Plaza Hotel (Attn. Mr. Junichiro Matsuyama)63 Samsenthai Road, PO.Box 6708, Vientiane, Lao PDRPhone: +856(21)218800 Fax: +856(21)218808E-mail: sales@laoplazahotel.comWebsite: http://www.laoplazahotel.com/Title: ……………. First Name: …………………….. Last Name: ……………………………...Company/Organization: …………………………………………………………………………..Address: ………………………………………………………City: ……………………………...Country: ……………………………………Postal Code: ………………………………Telephone: ……………………….Fax: ………………………….E-mail: ………………………..Payment for one night deposit through Credit Card:□VISA □MasterCard □AMEX □JCBCard Number: ………………....………..………………….Expiry (Month): …………(Year) ………..• Credit card information is mandatory and your reservation will not be completed without the information.Check-in date □ 15 June 2011 □Others:Check-out date □ 16 June 2011 □ 17 June 2011 □Others:Total:nightsFlight Information:(1) Date of Arrival:To Lao PDR: Flight no.(2) Date of Departure:From Lao PDR: Flight no.* Transportation between the International Airport and the venue will be arranged based onparticipants’ flight schedule if you stay at Lao Plaza Hotel. If you do not provide your flight number inadvance, transportation service is not available.Room type: SingleRoom rate: 900.000KIP (approx. 112USD as of May 07, 2011) incl. internet connection feeSpecial Requests, if any:…………………………………................1