21st Ka and Broadband Communications Conference

Bologna, October 12-14, 2015

HOTEL RESERVATION FORM

Hotel Internazionale – Via dell’Indipendenza, 60 – 40121 Bologna (Italy)

Dear Guest, Thank you for choosing the Hotel Internazionale. Please complete this form and fax or e-mail to Reservation Department, fax: + 39 051 249544, e-mail:

First & Family Name

Company Address

City ZIP/Postal Code Country

Telephone Fax

E-mail address

Accommodation rates (inclusive of VAT currently at 10% and buffet breakfast)

double room single occupancy Standard Category Euro 104,00 per room, per night

double room double occupancy Standard Category Euro 124,00 per room, per night

supplement De Luxe room Euro 30,00 per room, per night

Arrival date Departure date No. nights

First & Last Name accompanying person and arrival/departure dates:

City tax Euro 2,50 per person per night in double room single occupancy and Euro 1,50 per person, per night in

double Room double occupancy Standard Category – De Luxe double room single occupancy Euro 4,00 p.p. per night

Check in from 14:00 PM and check out within 12:00 AM

PAYMENT:

Please be informed that your reservation can only be processed only if your credit card number is added to this page. Confirmation will ne subject to hotel availability. Please call + 39 051 245544 for more information.

Visa Mastercard Diners American Express

Credit card No. Expiring date

Credit card holder Name and Last name

Credit card holder signature

The delegates are responsible for setting their own accommodation & incidental charges upon departure.

-  No charge for cancellation notified via e-mail by 14:00 PM 2 days prior to the arrival date.

-  One night room rate charge for cancellation after such time and date.

-  Total amount of the pre-booked stay for no-show.

-  Early departure: the hotel will charge an early departure fee equivalent to the daily room rate for departure prior to confirmed departure date.

Please submit this form (1 per room) to internazionale@monrifhotels,it or fax to + 39 051 249544

Date: Signature

http://www.hotelinternazionalebologna.com/