Hotel room Registration FORM

EBF Workshop

Industry input into ICH M10:

Experimental data as the cornerstone to a science driven bioanalytical guideline

25-26 September 2017, Altis Grand Hotel, Lisbon

For confirming your reservation, you are kindly requested to fill the present form and return it to us duly signed. In order to secure space, reservation forms should be sent to our Group Sales Department e-mail prior to 15th July 2017. Our reservations department will confirm back your reservation when all information is received. Any booking form received after the above deadline, will be offered the best available rate at that time, subject to hotel´s availability.

RESERVATION DETAILS

Family Name______First Name______

Address______

Telephone______Email ______

Country______

Passport Number*______Exp Date*______Place of issue*______

Birthplace*______Birth date______

Day of Arrival______Day of Departure______

Arrival time______

ROOM RATES (will be valid for arrival dates of 24th September and departure dates until 27th of September)

Single Room - € 145

Double Room - € 165

Rate includes buffet breakfast, internet, taxes and service. This rate is valid until 15th July 2017. After that date, Altis Grand Hotel can change the price based on rates applicable for the season.

Payment and Cancellation Conditions

Cancelation can be made with no additional charges up to 31st July 2017.

Room cancellation made between the 31st July and the 31st August 2017 will be charged one night penalty

In case of cancellation after the 31st August 2017 or in case of no-show or early departure, full stay will be charged. All deposits are non-refundable and non-transferable

o Visa Access/Master Card o Dinners o American Express

Card number______Expiry Date______

Three last numbers of the digit security code authorization is needed (see at the back of your card) ______

***A clear copy of both sides of your personal credit card is required***

Third party credit card can only be accepted if the card and the cardholder are present upon check-in

OR

You may proceed with the pre-payment of one room night non-refundable.

Please contact us at to do access our Secured Integrated System.

Signature:

Date:

We thank you and are looking forward to welcoming you in ALTIS GRAND HOTEL

Altis Grand Hotel – Rua Castilho, 11, 1269-072 Lisboa, Portugal - Fax (+351) 21 310 60 61 - Tel (+351) 21 310 60 22

E-mail: http: www.altishotels.com