Hotel Booking Form
Keyword: IAU Symposium 200
fax to
Hotel Mercure
# (49) 331 - 29 34 96
Lange Brücke

Room type:   O single 120 DM   O double 142 DM

Arrival & departure of your stay:

Date of Arrival: (dd/mm/yy)
Date of Departure: (dd/mm/yy)

Your details:

Title:
First Name:
Last Name:
E-mail:
Address:
City:
Country:
Zip/Postcode:
Telephone:
Fax:

Your payment details:

Credit Card Type:
Credit Card No.:
Expiry Date:
Name on Card


Signature: .............................................................................


Acknowledgement:


...........................
Date


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Hotel Mercure