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Please print and complete this form and fax or mail to:
Please complete the following information and return by June 25, 2001. You may also download this form as word document 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, 2001. 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: 2nd International Congress on Heart Disease__________ (Hotel use only) Arrival Date: __________________ Arrival Time: ______________ Departure Date: ____________ Preferred Accommodation (subject to availability):
Rates for suites are available upon request. Do you require a room accessible to the physically challenged? r Yes r 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, 2001 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 r . 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: r American Express r Visa r 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. |
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