HUSITA8 - Room Reservation 89 Chestnut

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Participant Information

Title

Select Prof. Dr. Mr. Mrs. Ms.

Contact Name

Given Name(s)*

Family Name*

Organization/Company

Phone

Fax

Email*

Name of companion

Given Name(s)

Family Name

Hotel Accommodation

Arrival Date

Departure

# of Nights

Please indicate the room type required: Single (1 double bed for 1 person), Twin (2 double beds for 2 people), Double (1 double bed for 2 people). Note one or two breakfasts are included daily, depending on room type chosen.

Please Select Room Type
Single – CD$89.00 US$81.00
Twin or Double – CD$99.00 US$90.00

Room Type

Single Twin Double

The above room rates exclude taxes (currently 6% GST, 5% PST & 3% DMF). U.S. dollars rates are approximate and are subject to exchange rates. For current exchange rates for various currencies go to http://www.xe.com/

Special Requirements (e.g. physical disabilities, etc.)

Payment Method (please check one)

Please Select Credit Card Cheque Bank Draft

Contact for Further Information

Doreen Ostrowski
Polestar Meeting Group Inc. 284 Withrow Ave., Toronto, ON, M4J 1B7
Tel. 416-465-8756 - E-mail: Doreen.husita8@sympatico.ca

Privacy Statement: Information collected on this form will only be used for conference purposes. Personal information will not be shared with any other organization. If you have any questions, please contact the conference secretariat.

89 CHESTNUT RESIDENCE REGISTRATION FORM www.89chestnut.com - Conference Centre, University of Toronto

Please complete the following (* - required data)

89 CHESTNUT RESIDENCE REGISTRATION FORM
www.89chestnut.com - Conference Centre, University of Toronto