IAIFA Annual Meeting



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CochraneGM18

March 17th to 25th, 2018

Return this form via email or fax, until 26/01/18, to: vera.melo@

Phone: +351 21 318 27 94

fax:+351 21 318 27 99



Hotel’s Room Accommodation

Olissippo Oriente****

(Av. D. João II, Lt 1.03.22 – 1900-083 Lisboa Parque das Nações)

Phone: +351 21 89 29 100 – Fax: +351 21 89 29 119

Delegate’s Information

|First Name | |

| | |

|Surname/Family | |

| | |

|Title |( Prof ( Dr ( Ms ( Mrs. ( Mr. |

| | |

|Organization | |

| | |

|Name of accompanying | |

|spouse/person | |

Contact Information

|Address | |

| | |

|Country | |

| | |

|Phone/Fax |( ) - |

| | |

|Email | |

Payment Information

| Room Accommodation Rate | | |

| | | |

|( Single Standard room – 100 Euros (bed and Breakfast) | | |

|( Double – 110 Euros (bed and Breakfast) | | |

| | |I authorize Olissippo Oriente to use my credit card to guarantee the above booking and confirm that I |

|The rates are per room occupancy. | |accept the above terms and conditions: |

|City tax: € 1 per pax/per day | | |

| | |( |

| | |Credit Card Number: |

|Reservation dates: | |Expiring Date: |

| | | |

|Arrival: | |Cardholder signature: |

|Departure: | |(as it appears on card) |

| | |Secure Nb: |

| | | |

| | | |

| | | |

| | |OR |

| | | |

| | |( Wire Transfer (ref. no. ---------------------) Please wire funds to: |

| | | |

| | |Sociedade Hoteleiras Seoane SA |

| | |Avenida da Republica, nº15, 1050-185 Lisboa, Portugal |

|Payment method: | |Bank Name: Caixa Geral de Depósitos |

| | |Routing Number (Swift Code): CGDIPTPL |

|( | |Account Number/IBAN:  PT 50 0035 0001 00013018330 37 |

|Credit Card Number | |The room’s rates include Buffet Breakfast and the local official taxes |

|Expire Date: | | |

| | | |

|Owner’s name: | | |

|Secure Nbr: | | |

| | | |

| | | |

| | | |

|OR | | |

| | | |

| | | |

|( Wire Transfer (ref. no. ---------------------) Please wire funds to: | | |

| | | |

|Sociedade Hoteleiras Seoane SA | | |

|Avenida da Republica, nº15, 1050-185 Lisboa, Portugal | | |

|Bank Name: Caixa Geral de Depósitos | | |

|Routing Number (Swift Code): CGDIPTPL | | |

|Account Number/IBAN:  PT 50 0035 0001 00013018330 37 | | |

| | | |

|OR | | |

| | | |

| | | |

|( At Check-in | | |

Cancellation Policy:

• Free of Charge – until 48 hours before arrival date.

• One (1) night fee for reservations cancelled between 48 and 24 hours prior to the arrival date.

• Full stay will be charged for reservations cancelled less than 24 hours prior to the arrival date. (all changes and cancellations must be received in writing).

• Penalty fee of 100% in case of No Show

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