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Contact Info:
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| First Name:* |
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| Last Name:* |
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| Institution/Affiliation: |
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| Country *: |
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| City/State: |
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| Primary phone No: (please include country code) |
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| alternate phone No: (please include country code) |
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| Fax: (please include country code) |
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| Email:* |
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Room type and number of rooms :
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| Single: |
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| Double: |
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| Triple: |
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| Suite: |
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| Extra bed: |
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| Number of adult persons: |
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| Number of children up to 12 years: |
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| Date of birth of children: |
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Additional Comments/
Special needs or requirements |
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