INTRANET

Hotel reservation form

Could you please print out this hotel reservation form and fax it before the 1st of June 2004 to: +31 53 434 0392

Gillian Luisman

CHEPS,

University of Twente,

PO Box 217,

7500 AE Enschede,

the Netherlands

Fax number: +31 53 434 0392

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Conferentiehotel Drienerburght

Universiteit Twente

Drienerlolaan 5
7522 NB Enschede
Tel.: +31 53 - 433 13 66

Fax: +31 53 - 435 67 70

Email: info@drienerburght.nl

Website: www.drienerburght.nl

Name (Mr/Mrs)

………………………………………………………………

First name and title

………………………………………………………………

Organisation

………………………………………………………………

Department

………………………………………………………………

Address

………………………………………………………………

Postcode and City/District

………………………………………………………………

Country

………………………………………………………………

Telephone

………………………………………………………………

Fax

………………………………………………………………

E-mail

………………………………………………………………

Date and time of arrival

………………………………………………………………

Date and time of departure

………………………………………………………………

q

Single room

q

Double room use: 1 or 2 persons

Note: if you choose ‘double room’ please indicate if you want to share it with a colleague or not.

Dietary requirements, please indicate:

Date:

Signature: