The Royal College of AnesthesiologistDuring 18-20 August 2017

HOTEL RESERVATION FORM

Complete ONLY if you wish to make a reservation through the hotel.

DELEGATE INFORMATION(Please complete all fields in CAPITAL letters)
 Dr  Mr  Mrs  Ms / Confirmation# (for Hotel fill in only):……………...
Family name:…………………………………………………... / First Name:……………………......
Company:.…………………………………………………………………………………………………………………..
Company Address:…………………………………………………………………………………………………………
Postcode:…………...... / City:.………………………… / Country:…..…………………………………………
Phone:………………………………………………………….. / Fax:…………………………………………………..
Arrival Date:………...... / Arrival Time:………...... / Flight No:.……………………………………………
Departure Date:.………...... / Departure Time:………….... / Flight No:…………………………………………….
Special Requests:  Non Smoking  Smoking
ACCOMMODATION
*Please book on my behalf inDusit Thani Bangkok No. of nights
Address: 946 Rama IV Road, Bangkok 10500, Thailand
Tel: 66 2200 9000 Fax: 66 2200 9600 website:

Superior Room Deluxe Room Dusit Room Thai Héritage Suite
Room Type / Room Rate/night*
One King Size Bed / Two Single Beds / Check In
Date & Flight / Check Out Date & Flight
The Heritage Suite
(one bedroom)(80 Sqm.) /  Single Baht 9,500 net  Twin/Double Baht 9,500 net
Dusit Room (Jr. Suite 60 Sqm.) /  Single Baht 6,500 net  Twin/Double Baht 6,500 net
Deluxe Room (Tower Wing) 30 Sqm /  Single Baht 4,500 net  Twin/Double Baht 5,000net
Superior Room (East Wing) 35 sqm /  Single Baht 3,500 net  Twin/Double Baht 4,000 net
Room Privileges:
  • Compliment breakfast and internet in room (Broadband/RIFI use in-room and WIFI connections public areas)
  • Compliment Welkom drink, fresh fruits in room
  • complimentary use of DFit Fitness Club

Remarks: Hotel rooms can only be guaranteed if bookings are made before 15th July 2017(One night room rate will be charged for deposit.)
In order to guarantee your reservation at the above mentioned hotel, please indicate your Credit card no. below :
Expiry date : (mm/yy)
Cardholder’s Name (as it appears on the credit card): ______
Type: □Visa / □Master Card / □American Express
Date:______Signature:______

*Note :

1) The preferential rates are inclusive of 10% Service Charge & 7% VAT per room per night.

2) The hotel bill must be settled on an individual basis upon checking out of the hotel.

3) One night room rate will be charge in the event of NO-SHOW or notification of cancellation less than 7 days prior to arrival.

4) Any alteration in your hotel booking must be addressed the hotel directly

5) All attendees will be required to supply the Hotel with a credit card imprint or 2,000 baht (per night) cash deposit (refundable) upon check-in to cover charges to individual personal accounts. In case where credit card or cash isn’t provided the hotel will not post any expenses to the attendees room and payment will need to be made upon request of the service (restaurant, laundry, etc.)

AIRPORT TRANSFER Yes: Please arrange airport transfer Mercedes Benz (please advice before 2 days)

From airport to hotel or hotel to airport price at Baht 2,500 - net per car per trip

Round trip transfer price at Baht 5,000 - net per car per trip

Please return the completed Registration Form on or before15th July 2017by fax or scan to our Reservation Office: E-mail:

Tel : 66 2200-9000 Ext. 2172-2177 Fax. : 66 2636-0284

Hotel Liaison : Miss Sachon Thiraprawat (Director of Sales) E-mail: , Tel: 66 2200-9000 Ext. 2909 Fax. 66 200-9600 Mobile 66 91-982-6592

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