Application Form for Hotel Accommodations   “The 6th International Conference on Laser Ablation (COLA’01)”
month    day     2001
To:  JTB Tsuchiura Office	Secretariat use	
     Fax: +81-298-24-1940  (Local: 0298-24-1940) 	Rc. No.		
			
  (Please type or print in block letters and check appropriate boxes (□).)
Name in full of group representative	

	Address       ( □ Business / □ Home )

Tel:                         Fax:                
e-mail                       
	Contact person
(Your secretary’s name)

	
Organization	

Method of payment
  □ Credit card
  □ Bank transfer*
*Domestic participants only	By credit card	Card type       (                        )
Card number    (                        )
Name of holder  (                        )
Expiration date   (            /           )	In case of remittance
Domestic participants only	Details (such as bank account) will be stated on the invoice.	
	Name	Age	Sex	Hotel name and code	Room type	Roommate	Date of stay (Please encircle.)	
							Sep30	Oct 1	Oct 2	Oct 3	Oct 4	Oct 5	
(e.g.)	Henry Tsukuba	50	M	Okura Frontier Hotel Epochal  (B)	Twin	Mary Tsukuba	O	O	O	O	O		
1	
												
2	

Date:                       Signature:                                

(1) Application should be made by completing this form and sending it by fax to reach JTB no later than July 31, 2001.  
(2) Be sure to keep a copy of your application.
(3) If application is for three or more persons, please copy this form.	Application addressed to:
JTB Tsuchiura Office
c/o “COLA’01” Desk
Persons in charge: Inanobe, Kazama, Doi
Urara 6, 9-2 Yamato-cho, Tsuchiura-shi, Ibaraki-ken 300-0036
Fax:+81-298-24-1940
e-mail address: tsuchiura_ei1@kit.jtb.co.jp