Hotel Reservation Form
Complete and mail this reservation form to the hotel. It must arrive on or before Monday, February 4, 2002.
Reservations The Boston Park Plaza Hotel 64 Arlington Street Boston, MA 02116-3912 617-426-2000 Phone 617-423-1708 Fax 800-225-2008 Reservations http://www.bostonparkplaza.com
Specially discounted guest rooms are being held for SIAM meeting attendees until Monday, February 4, 2002. After that date, reservations will depend on availability. Your reservation is not confirmed until acknowledged in writing by the hotel or verified by phone. When making reservations by phone, be sure to identify yourself as an attendee of the SIAM Conferences on Imaging Science and Life Sciences. Be sure to request 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: $165.00 Double: $180.00 Student: $123.75 Rates are subject to prevailing state and local taxes @ 12.45% Each additonal person in room $20.00 Arrival Date _____/_____ Arrival Time _____:_____AM/PM Departure Date _____/_____ Guarantee my room for late arrival (after 6:00 PM) ____Yes ____No I choose to pay my deposit for the first night's room rate by (please circle) VISA MasterCard American Express Check Credit card no.__________________________________________________________ Exp. Date______/______ Please send me a confirmation notice. Yes _____ No _____ Your e-mail address _______________ Complete and mail or fax this reservation form directly to The Boston Park Plaza Hotel. Questions? E-mail firstname.lastname@example.org. SIAM wishes to take steps to ensure that no individual with a disability is excluded, denied services, segregated or otherwise treated differently than other individuals because of the absence of auxiliary aids and services. If you need any auxiliary aids or services identified in the Americans with Disabilities Act, or assistance in registering for this conference/meeting, please notify the hotel when making reservations.