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AUTORISATION DE PAIEMENT PAR CARTE DE CREDIT
AUTHORISATION OF PAYMENT BY CREDIT CARD
REGISTRATION FORM
6th European Congress on Hematologic Malignancies
February 25th–28th, 2010
Please kindly complete and return this form to our Reservations Department
Fax: 04 93 06 46 00 – Tel: 04 93 06 45 67/71/72
For more than 4 bedrooms, please send your request to: [email protected]
1) Name:
__________________________ Surname: ________________________
2) Name:
__________________________ Surname: ________________________
3) Name:
__________________________ Surname: ________________________
4) Name:
__________________________ Surname: ________________________
Address of the card holder:
__________________________________________
_________________________________________________________
Fax n°/e-mail: __________________________
Arrival Date :
Single Room € 150
Departure Date:
Double Room € 175
The above rates are per room and per night, Continental buffet breakfast, VAT and service included.
City Tax is additional (currently € 1.30 per person and per night).
Extension of stays is proposed at the above preferred rates, on request, upon availability.
In order to guarantee your reservation, please kindly complete your credit card details with expiry
date, CVC number and signature of the card holder. Please kindly note in case of cancellation
after February 19th, 2010 the equivalent of the total stay will be charged on your credit card as a
penalty as well as for shorten stay and no-shows. This amount is non refundable.
Signature : ____________________
Credit Card Number
Expiry Date
CVC Number
________________________________________________________________________
Dear Sirs,
It is with much pleasure that we confirm the above mentioned reservation in your favour. Please kindly note your
confirmation n°:________________________________________________
We look forward to welcoming you at the InterContinental Carlton Cannes
Kind regards,
Reservations Department
InterContinental Carlton Cannes
SNC Carlton Danube Cannes au capital de € 8.000 - R.C.S. B 332 759 877 Cannes - Siège social : 58 La Croisette 06400 Cannes
Locataire Gérant de la Société des Hôtels Réunis (SAS) .R.C.S. B 572 141 182 Paris
Société gestionnaire : HH France Holdings Sarl sis au 5 place de l’Opéra, 75009 Paris
Société Générale Nice Arénas AB/RIB 30003 00958 00020040212 IBAN 93 CODE SWIFT : SOGEFRPP -ID TVA FR69332 759877
Tél. +33 (0)4 93 06 40 06 - Fax +33 (0)4 93 06 40 25 - www.intercontinental.com/cannes - [email protected]