LC2000 and ELSS 2000 -- Hotel Form

Full Name (Last, first):

Fax number:

E-mail address:

Postal address (to which your receipt will be sent):

Other relevant information:

If you are sharing a room and will arrive separately, names of the person sharing the room with you.

Hotel you wish to reserve a room in:

Type of room desired (Single, Twin, Double, or explain):

Bath or shower:

Date of arrival, and estimated time of arrival if you are going to arrive late:

Date of departure:

(please fill in the blanks)

I authorise Central Voyages to debit my credit card ________________

Nr _ _ _ _  _ _ _ _  _ _ _ _  _ _ _ _ , expiring on         /        , of the amount billed to

Central Voyages by the Hotel ___________

Name as it appears on the card
Date                                   Signature

Please fax this form to:
Central Voyages
29, rue du Pont-Neuf
75001 Paris
Fax: 33 1 42 36 29 33

Please note: This authorisation form is to be used ONLY in case you choose a hotel of the 1st list. This form should NOT BE USED for hotels in which you make the reservation yourself.