MATHEMATICS AND ITS APPLICATIONS

ACCOMODATION FORM
To send  by fax before 15/04/06  to +39.011.6603973


Please fill the form with all personal data, room type and duration of your stay.
A confirmation will be sent by mail, fax or E-mail reporting the address of the residence 
assigned.

 Full Name ________________________________________


 Address _________________________________________

 
City / Country______________________________________


Phone_____________________Fax_____________________



E-mail____________________________________________


Arrival__________________Departure__________________





Total  nights______

Room Type: 
<> single  €   45,00 B.B./night
<> double €  35,00 B.B./night per person




CREDIT CARD  GUARANTEE : 

No reservation will be confirmed without a credit card guarantee . In case of no-show the 
Residence will charge one night penalty upon your credit card. Payment will be settled 
directly in residence, upon check-out.

AmEx ?	             Eurocard ?		  Diners ?		Visa ?			 Master ?

N°................................………………………………………… Exp. date ....../...... (mm/aa – mm/yy)

Name   …..…………………………….    Signature ……………………………