Renaissance
Kota Bharu Hotel
Kota Bharu, Malaysia

10th ANNUAL PERINATAL CONGRESS
27th FEBRUARY 2003 - 2 MAC 2003

ROOM RESERVATION FORM

Arr Date Carrier Arr Time Dep Time Carrier Dep Time
   

AM          PM
   

AM          PM

Name:
(Prof / Assoc Prof / Dr / Mr / Mrs / Ms)
C/Card:
(AMEX / VISA / MASTER / DINNERS CLUB /JCB)
Home Address:
 
Telephone:
Mobile Phone:
Fax:


Number of Rooms Requested, Rate Charged and Special Request

Room Type RM Rate No of Room Special Request
Deluxe Single 145.00 Nett  

Deluxe Double 160.00 Nett  

Junior Suite 275.00 Nett  


Method of Payment:


Signature:

Date:

Note: For reservation please contact Puan Liza / En Azam at:
Tel: 09-746 2233 or
Fax: 09-747 0702