Hotel Reservation Form
Hotel Reservation Form SIAM Conference on Mathematical and Computational Issues in the Geosciences (GS03)
Your reservation is not confirmed until acknowledged in writing by the hotel or verified by phone. When making reservations by phone, please identify yourself as an attendee of the SIAM Conference on Mathematical and Computational Issues in the Geosciences. Be sure to get a confirmation number!
Please do not send this form to SIAM.
Name_______________________________________________________________________ First Middle Initial Last Address______________________________________________________________________ City_______________________________________State________Zip____________________ Telephone_____________________________________________________________________ Fax__________________________________________________________________________ E-mail ________________________________________________________________________ Please reserve a (please circle) Single/Double $ 139.00++ per night (Approximately $160 including tax)
All room rates based on availability.
Arrival Date _____/_____ Arrival Time _____:_____AM/PM Departure Date _____/_____ Guarantee my room for late arrival (after 6:00 PM) ____Yes ____No Cancellation policy for non-guaranteed rooms is 24 hours. I choose to pay my deposit for the first night's room rate by (please circle) VISA MasterCard American Express Diners Club Japan Credit Bureau Discover Carte Blanche Credit card no.__________________________________________________________ Exp. Date______/______ Name as it appears on the card: _________________________________________ Signature: ______________________________________________________________ If a credit card is provided, the room is guaranteed for late arrival after 4:00 PM Eastern Daylight Time. Please send me a confirmation notice. Yes _____ No _____ Your e-mail address ________________________ ALL RESERVATIONS MUST BE GUARANTEED WITH CREDIT CARD OR DEPOSIT. Complete and mail or fax (512) 473-1502 this reservation form directly to the Radisson Hotel and Suites. Questions? E-mail firstname.lastname@example.org. GS03 Home