[HOTEL BOOKING FORM]{.mark}

# 

#  I.Personal Particulars OF person (Please fill in clearly)

+-----------+---------------+------------------+-----------------------+
| Identi    | **Mr / Ms /   | □                | □ **Representative    |
| fication: | Mdm / Dr /    | **Participant**  | from ASEAN            |
|           | Prof**        | □ **Speaker**    | Secretariat**         |
|           |               |                  |                       |
|           | □             |                  |                       |
|           | *             |                  |                       |
|           | *Government** |                  |                       |
+-----------+---------------+------------------+-----------------------+

\|\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\| /
\|\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\|
/ \|
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\|\
First Name Middle Name Last Name

Job Title
\|\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\|
Department
\|\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\|

Institution
\|\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\|

Mailing Address
\|\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\|

City \|\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\|
State \|\_\_\_\_\_\_\_\_\_\_\_\_\_\| Postal Code
\|\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\| Country
\|\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\|

Country/Area Code \|\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\| Phone
\|\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\| Fax
\|\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\|

E--mail address
\|\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_I

# II.Personal Particulars OF Accompanying Person (If sharing room with someone, please give his / her details as below)

+-----------+---------------+------------------+-----------------------+
| Identi    | **Mr / Ms /   | □                | □ **Representative    |
| fication: | Mdm / Dr /    | **Participant**  | from ASEAN            |
|           | Prof**        | □ **Speaker**    | Secretariat**         |
|           |               |                  |                       |
|           | □             |                  |                       |
|           | *             |                  |                       |
|           | *Government** |                  |                       |
+-----------+---------------+------------------+-----------------------+

\|\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\| /
\|\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\|
/
\|\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\|\
First Name Middle Name Last Name

Job Title
\|\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\|
Department
\|\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\|

Institution
\|\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\|

Mailing Address
\|\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\|

City \|\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\| State
\|\_\_\_\_\_\_\_\_\_\_\_\_\| Postal Code
\|\_\_\_\_\_\_\_\_\_\_\_\_\_\_\| Country
\|\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\|

Country/Area Code \|\_\_\_\_\_\_/\_\_\_\_\_\_\| Phone
\|\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\| Fax
\|\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\|

E--mail address
\|\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\|

**\*Please Indicate: (1) for most preferred, (2) for 2^nd^ Choice, (3)
for 3^rd^ Choice and your room requirements.**

<table>
<colgroup>
<col style="width: 20%" />
<col style="width: 12%" />
<col style="width: 7%" />
<col style="width: 8%" />
<col style="width: 8%" />
<col style="width: 8%" />
<col style="width: 9%" />
<col style="width: 6%" />
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<col style="width: 5%" />
<col style="width: 6%" />
</colgroup>
<tbody>
<tr class="odd">
<td rowspan="2"><p id="name-of-hotels" class="heading">Name of
Hotels</p></td>
<td rowspan="2"><strong>Room Type</strong></td>
<td colspan="2"><p><strong>Room Rate is US$</strong></p>
<blockquote>
<p>(per room/per night)</p>
<p>With breakfast</p>
</blockquote></td>
<td colspan="2"><p><strong>Pick up</strong></p>
<p><strong>Service</strong></p>
<p><strong>(1 way)</strong></p></td>
<td><p><strong>Choice Preferred</strong></p>
<p><strong>In Numeric Order</strong></p></td>
<td><strong>Single</strong></td>
<td><p><strong>Twin/</strong></p>
<p><strong>Double</strong></p></td>
<td><p><strong>No of</strong></p>
<p><strong>Nights</strong></p></td>
<td><p><strong>Pick up Service</strong></p>
<p><strong>(Y or N)</strong></p></td>
</tr>
<tr class="even">
<td><strong>Single</strong></td>
<td><strong>Twin/ Double</strong></td>
<td><strong>4 seats</strong></td>
<td><strong>minivan</strong></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="11"><strong>OFFICIAL HOTEL</strong></td>
</tr>
<tr class="even">
<td>Hanoi Horison Hotel</td>
<td>Deluxe</td>
<td>86++</td>
<td>101++</td>
<td rowspan="4">28 nett</td>
<td rowspan="4">40 nett</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td rowspan="2"></td>
</tr>
<tr class="odd">
<td></td>
<td>Horison Deluxe</td>
<td>92++</td>
<td>107++</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td>Pool View Deluxe</td>
<td>98++</td>
<td>113++</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td>Executive Room</td>
<td>120++</td>
<td>140++</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
</tbody>
</table>

All room rates are subject to 5% Service Charge & 10% VAT. The rates
include Buffet breakfast, free use of Fitness center & swimming pool,
Free mineral water & Local news paper, Tea/coffee making facilities in
your room.

**For Hotel Information:**

Hotel Check-in Date: [\_\_\_\_\_\_\_\_\_\_]{.underline} Flight details:
[\_\_\_\_\_\_\_\_\_\_\_\_\_]{.underline} Arrival Time:
\_\_[\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.underline}\_\_\_\_\_\_\_\_\_\_\_\_\_

Hotel Check-out Date: [\_\_\_\_\_\_\_\_\_\_]{.underline} Flight details:
[\_\_]{.underline} Departure Time:
\_\_\_[\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.underline}\_\_\_\_\_\_\_\_\_

**Other Personal Information:** (Please check your preferences)

**Food Preference** □ No Preference □ No Pork No Lard (Non-Halal) □
Vegetarian

**Room Type Preference** □ Smoking □ Non-Smoking

III\. MODE OF PAYMENT (YOU ARE NOT REGISTERED UNTIL PAYMENT IS
RECEIVED.)

□ Credit Card \[please select one\]

□ Visa □ MasterCard □ American Express

> ***Credit Card Number :
> \|\_\_\_\_\_\_\_\_\_\_/\_\_\_\_\_\_\_\_\_\_\_/\_\_\_\_\_\_\_\_\_\_\_/\_\_\_\_\_\_\_\_\_\_\_\|
> Expiry Date: \|\_\_\_\_\_\_\_\_/\_\_\_\_\_\_\_\_\_\|*** (15 digits for
> AMEX, 16 digits for VISA/MASTER) (mm / yy)
>
> The security code three digit appearing on back of the signature panel
> for Visa/Master card or the four digit appearing on the front panel
> for AMEX \|\_\_\_\|\_\_\_\|\_\_\_\|\_\_\_\|
>
> Card Holder's Name :
> \|\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\|
>
> (name as in credit card)
>
> **I hereby authorize this payment for the amount of US Dollars (US\$)
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**
>
> **Signature of Cardholder**:
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (Essential)
> **Date of Authorization**: \|\_\_\_\_/\_\_\_\_/\_\_\_\_\_\_\|

(Authorizing Charge and Acknowledging Cancellation Policy) ( dd / mm /
yy )

**Conditions:**

1.  RESERVATIONS WILL NOT BE PROCESSED IF FORMS ARE INCOMPLETE. EMAIL &
    TELEPHONE REQUESTS ARE NOT ACCEPTED.

2.  All official hotels require a credit card number and expiry date to
    secure reservation. The remaining payment should be settled at
    check-out and will be charged in US Dollars. Any cancellation must
    be notified in writing to Viet Event Co., Ltd. In case of
    cancellation after 30 June 2007 or no show, your credit card will be
    charged the cost of one night's accommodation.

3.  Pick up fee: The Hotel will charge full rate in the case of
    cancellation or delayed without informing hotel in advance

4.  Please fax the completed HOTEL BOOKING FORM to with a copy to:

+-------------------------------------+--------------------------------+
| **Nguyen Mai Lan (Ms.)**            | **Mr. Nguyen Tu Hieu**         |
|                                     |                                |
| **Viet Event Co., Ltd.**            | **Department of Medical        |
|                                     | Equipment and Construction**   |
| **Unit 202, Grand Somerset Hanoi    |                                |
| Towers**                            | **Fax: 84 4. 266 3278**        |
|                                     |                                |
| **49 Hai Ba Trung, Hanoi, Vietnam** | **Email:                       |
|                                     | thietbiyte@yahoo.com**         |
| **Tel: 84 4. 936 4552/ Fax: 84 4.   |                                |
| 936 4563**                          | **Mobile: + 84 904050626**     |
|                                     |                                |
| **Email:                            |                                |
| <nguyenmailan@vietevent.com.vn> and |                                |
| <nguyenmailan@fpt.vn>**             |                                |
|                                     |                                |
| **Mobile: +84 904442099**           |                                |
+-------------------------------------+--------------------------------+

5.  Room bookings through airline programmes and travel agents will not
    be entertained by the hotels.

6.  Please retain a copy of this form for your record.

7.  Within five working days from receipt of Hotel Registration Form, an
    acknowledgement note with a confirmation number will be issued to
    you via email or fax only. Please state clearly your email address
    and fax number in the form.

8.  As a limited number of rooms have been reserved for participants,
    please make and confirm your booking promptly. The closing date for
    hotel reservations **is 30 June 2007**.