Family Name: | ________________________ | Other Names: | ___________________________________ |
Affiliation & Address: | ___________________________________________________________________ |
___________________________________________________________________ | |
___________________________________________________________________ |
Tel: | ______________ | Fax: | ______________ | E-Mail: | ___________________ |
[ ] Request an extra copy of book of abstracts at an additional charge of US$ 10 to be paid on site |
[ ] Accompanied by | Spouse and _______ children aged _________ |
Room Request in Adora: | _____     nights | from: |       /      / 2002 | to: |        /       / 2002 |
Hotel Room : | [ ] Single Rm | [ ] Double Rm | [ ] Triple Rm |
Club Room : | [ ] Single Rm | [ ] Double Rm | [ ] Triple Rm |
Full name of the other participant(s) if you have a preference: | ____________________________________ |
Date:     _____________________________ |
Registration fee | $ ______ |        [ ] I enclose a bank check payable to Faruk Arinc; or |
Accommodation (   ____  nights x US$ ______ = ) | $ ______ |        [ ] I enclose a copy of the bank transfer document; or |
      Total | $ ______ |        [ ] Please charge my credit card for the total amount |
Please charge ________ US Dollars to my: | [ ] Visa | [ ] MasterCard | [ ] Eurocard |
Card Number: | ____ ____ ____ ____ ____ ____ ____ ____ | ||
Expiry Date: | ___________________ | ||
Signature: | ___________________ | Date: | ___________________ |
Name as shown on Credit Card: | ____________________________________ |
Family Name: | _________________ | Other Names: | __________________________ |
I request transportation | |||
        [ ] From Antalya Airport to Adora |         [ ] From Adora to Antalya Airport | ||
Arrival Date: | _______________ | Departure Date: | _______________ |
Time: | _______________ | Time: | _______________ |
Flight No: | _______________ | Flight No: | _______________ |
From: | _______________ | To: | _______________ |
(last point of departure)      |                (first destination) | ||
Number in party : | ________ | ||
Name(s) of accompanying person(s): | _____________________________________ |
This form is to be printed, filled out and sent to ICHMT Secretariat by fax (+90-312-210 1331), email (arinc@metu.edu.tr), or snail mail.