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Please complete this form, print and fax/mail to:
The Hyatt Regency Washington on Capitol Hill
Reservations Department
400 New Jersey Avenue, NW
Washington, D.C. 20001
USA

Tel: +1 202 737 1234
Fax: +1 202 942 1576

You can download this form in PDF format (11Kb)

Please complete the following information and return by June 25, 2003.

This is a reservation request only. Your group has reserved a block of rooms at the Hyatt Regency Washington on Capitol Hill. This reservation will be honored until the block of rooms have been filled or until June 25, 2003. If a room has been secured for you at the Hyatt Regency Washington on Capitol Hill, written confirmation will be mailed to you by the Reservations Department.

Guest Name: __________________________________________________

Accompanying Person(s): _________________________________________

Company Name: ________________________________________________

Street Address: _________________________________________________

City: _________________________ State/Country: ___________________

Zip/Postal Code: ________Telephone: _________________________________

Fax: ______________ E-mail: _____________________________

Hyatt Gold Passport Number: _____________________________________

Convention/Group Code: 3rd World Congress on Heart Disease _________
(Hotel use only)

Arrival Date: _______________ Arrival Time: ____________ Departure Date: _________

Preferred Accommodation (subject to availability):
Smoking
Non-smoking
Single: One person
King: Two persons - one bed
Double/Double - Two persons - two beds
 

Room Rates: Single Double Triple Quad
  US$179 US$204 US$229 US$254

Rates for suites are available upon request.

** Rates do NOT include 14.5% sales tax and US$ 1.50 per room occupancy tax.

Do you require a room accessible to the physically challenged? Yes No

*** Please note: One night's room deposit must accompany this Reservation Request in order to confirm your reservation. Upon check-out, you will be charged for ALL nights confirmed above. Your reservation will NOT be confirmed until we receive your deposit. In the event you need to cancel, please do so prior to May 31, 2003 in order to receive a full deposit refund. After this date, no refund can be made.

Advance deposit can be made by cheque or credit card. If a cheque is enclosed, please mark here.

If you will be making an advanced deposit by credit card, please complete the information needed below:

Guest Name: ________________________________________________
Street Address: _______________________________________________
City, State: ___________________________________________________
Country: _______________________________ Postal Code: __________
Telephone: ________________________

Method of Payment: American Express Visa MasterCard
Credit Card No.: _________________________
Expiration Date: _________ (month/year)

Signature: _______________________________ Date: ___________

Please note: If you wish to make a direct bank wire transfer of your deposit, please contact the Reservations Department at the Hyatt Regency on Capitol Hill for further instructions.