6th IEEE International On-Line Testing Workshop
Workshop Hotel Reservation Form
Last Name: _________________________________________________________________
First Name: _________________________________________________________________
Organisation: _________________________________________________________________
Address: _________________________________________________________________
_________________________________________________________________
Tel. Nr.: ___________________________     Fax Nr.: ___________________________
E-mail: _________________________________________________________________
Hotel Nixe Palace Hotel Gran Hotel Ugo Palace
Arrival date: Departure date: Number of nights:
Special Requests:

ROOM RATES: all room rates are per day on American Buffet Breakfast Basis, with TAX included.
Nixe Palace Hotel Double room, single use: 21.000 Ptas Double room: 25.000 Ptas
Gran Hotel Ugo Palace Double room, single use: 10.000 Ptas Double room: 15.000 Ptas
RESERVATION: reservation request received by June 7th shall be honoured at the agreed rates. After June 7th availability of rooms is not guaranteed.
Payment by credit card: VISA or MASTERCARD
Card No: _________________________
Card Expiration Date: _________________________
Cardholder Signature:

To be returned by June 7th to:
Marga Barrera
Avda. 16 de Julio, 73
07009 Palma de Mallorca, Spain

Tel. Nr.: +34 971 766 460
Fax Nr.: +34 971 766 570
E-mail: Mbarrera@uex.es

If payment by bank transfer is preferred, send money to:
Ref. "IEEE" Ultramar Express BANCO DE SANTANDER, 0085.0749.43 Account Number 000.00.62.723, Gran Via Asima 2, Palma de Mallorca, SWIFT CODE BDERESMM.

Approximate currency rate: 1 EURO = 166.4 Ptas (Spanish Pesetas).

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Tous droits réservés.