[Intersection]

Accomodation Booking Form

Registration

This is an electronic accomodation booking form, if you are concerned by the possible security implications of sending your credit card information through the net, then please use the hotel booking form, which was included with Progress Report 5. 

Information about YOU
Forename:			
Surname:			
Initials:			
Title:				
Membership Number:       	

Enter your email address:    	

Enter your postal address:  	
				
				
				
				
				
Postcode:			
Country:			

Enter your telephone number: 	
Enter your FAX number:       	

Information about the accomodation you require.
Preferred Accomodation - 1	
Preferred Accomodation - 2	
Preferred Accomodation - 3	
Preferred Accomodation - 4	
Preferred Accomodation - 5	

Number of Nights required	
Cost Per night			
Total Due			 (Full payment for University Accomodation)

 Personal Priority	 Distance from SECC
Other Reason 


Accomodation Type

University:	 Basic	 En-suite	 Single		 Twin

Hotel:	 	 Single	 Double		 Family		 Twin

Hotel:		 Inc. Breakfast

I  wish to share with: (One form/One payment per room)

Forename:			
Surname:			
Initials:			
Title:				
Membership Number:       	

Enter their email address:    	

Enter their postal address:  	
				
				
				
				
				
Postcode:			
Country:			

Enter their telephone number: 	
Enter their FAX number:       	

Children - give ages:		


 I wish to get information on Bed and Breakfast accomodation.

Information about your stay.

Arrival Date:			
Departure Date:			
Duration of Stay (nights):	
Additional Reuirements (No Smoking/Disabled/Dietary needs):	

Payment/Guarantee

 I authorise you to debit my credit card - indicated below.

 Barclaycard	 VISA	 Access	 Mastercard
Credit Card Number:		
Expiry Date:			
Total Due:			

Name and address of cardholder if different from yours
Forename:			
Surname:			
Initials:			
Title:				
Membership Number:       	

Enter their email address:    	

Enter their postal address:  	
				
				
				
				
				
Postcode:			
Country: