The Sixth Conference of the International Coenzyme Q10 Association
Brussels, May 27-20, 2010
BOOKING FORM
DEADLINE : 30/04/2010
Please fill in the form in CAPITAL LETTERS and send it back directly to the hotel :
Mrs Valérie Wouters
EMAIL CONTACT valerie@hotelbedford.be
TEL: + 32 2 507.00.20
FAX: + 32 2 507.00.10
PARTICIPANT:
Title:
Surname:
Name:
Price per night, taxes and breakfast included
WEEK RATE single
Standard room week: 135,00 EUROS
Business room week: 160,00 EUROS
Executive room week: 185,00 EUROS
WEEK-END RATE
Standard room week-end: 110,00 EUROS
Business room week-end: 135,00 EUROS
Executive room week-end: 160,00 EUROS
double
Standard room week: 150,00 EUROS
Business room week: 175,00 EUROS
Executive room week: 200,00 EUROS
Standard room week-end: 125,00 EUROS
Business room week-end: 150,00 EUROS
Executive room week-end: 175,00 EUROS
Credit card details in order to guarantee the reservation:
Credit card number :………………………………………………………….
Expiration date :………………………………………………………….
Your reservation is valid and confirmed only if you have mentioned a credit card number. If you would like to cancel your room, please send a fax or a mail to the hotel 48 hours prior your arrival. In case of no show, the hotel is entitled to charge the credit card above-mentioned.
Hotel Bedford & Congress, Rue du Midi, 135-137, B – 1000 Bruxelles
Tél: + 32 2 507.00.20- Fax: + 32 2 507.00.10