Name:    
Address: 
City:     State:  Zip:
Country:  
Phone Number:  
Fax Number:    
Country Code: 
Email Address:  
Hotel - 1st Choice:   
Hotel - 2nd Choice:   
Hotel - 3rd Choice:   
Beds: (1 or 2) 
Smoking or Non-Smoking? - 
(subject to availability at the time of check in)
Arrival Date:   Month: Day: Year:
Departure Date: Month: Day: Year:#Nights:


Additional comments/information that will help us be responsive to 
your requirements -- such as:  have you been there before, are you 
familiar with the hotel, do you have flexibility on your dates, etc.