Name: Street:

City :

Postal code:

Country:

Telephone:

Fax:

E-mail:

Object (1):

Double rooms : 0 1 2 3

Triple rooms :... 0 1 2 3

Object (2):

Double room :.... 0 1

Triple room :....... 0 1

Fourfoldrooms : 0 1 2

Date of departure : Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month I II III IV V VI VII VIII IX X XI XII Year 2003 2004 2005

Remark: