Astrophysics from the radio to the submillimetre 
Planck and other experiments in temperature and polarization

ACCOMMODATION FORM

To be sent before January 13th, 2012 (fax number +39 0515876848 – momedaeventi@momedaeventi.com)

Family Name________________________________________  Name _________________________________________
			
Address _____________________________________________________________________________________________

ZIP CODE ___________ City____________________________ Country ________________________________________
				     	                       	
e-mail __________________________________________ Ph. _____________________ Fax ________________________
							   
uso singola di prenotazione
	Single room	Double room single use	Double room	
****   4 Viale Masini	----------	€ 129,00	€ 149,00	
****   Hotel Mercure	€ 110,00	€ 120,00	€ 130,00	
****   Una Hotel	----------	€ 110,00	€ 120,00	
****   Zanhotel Europa	----------	€ 104,00	€ 124,00	
****   Zanhotel Tre Vecchi	----------	€ 104,00	€ 124,00	
***sup   Hotel Metropolitan	----------	€ 110,00	€ 140,00	
***     Zanhotel Regina	----------	€   89,00	€ 109,00	
***     Hotel San Felice	€   70,00	€   93,00	€ 100,00	
***     Millennhotel	----------	€   79,00	€   89,00	
***     Nuovo Hotel Del Porto	€   70,00	€   75,00	€   88,00	
***     Hotel Re Enzo	----------	€   75,00	€   85,00	

Bed&Breakfast, VAT included

Hotel ________________________________  Arrival ____________________   Departure_____________________

You will receive hotel confirmation by e-mail. Please allow up to 10 days for mailed confirmation.

Second choice (if the choosen hotel is fully booked) _______________________________________________________

ROOM   
         □ Single room	    		 □ Double room single use	   	□ Double Room

Accompanying Person_________________________________________

PAYMENT

Hotel Reservation must be guarantee with a credit card. The payment will be done directly to the hotel at the check-out

□ Master Card		 □ Visa 		□ American Express

Card Holder _________________________________________      Signature ________________________________

Card Number  _____________________________________________ Expiry Date _________________________________

CANCELLATION POLICY

The Organizing Secretariat should be notified of cancellations in writing. 
If the Organizing Secretariat receives cancellations before 13 January 2012, only the first night will be charged. 
After 13 January 2012 the total amount of your stay will be charged on your credit card by the hotel. 
„No shows“ are non-refundable. 
If you cannot attend, you may send a substitute person. The original registrant must submit a written authorization for such a change.

By sending in this accommodation form, I acknowledge that I have taken notice of the cancellation terms on this form.

Date:     _________/________/_________			Signature:______________________________

   Momeda Eventi s.r.l.    	
   I - 40122 Bologna – Via San Felice, 38
    tel. +39 051 5876729 -  fax +39 051 5876848	       momedaeventi@momedaeventi.com    –     www.momedaeventi.com