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Skål International - Phuket
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PLEASE COMPLETE ONE FORM PER ROOM
MEMBER:
Current Membership Card No.:
Member's Family Name:
First Name:
Family Name of Accompanying Person:
First Name:
Skal Club of:
Position in Skal:
ADDRESS FOR CORRESPONDENCE:
Company Name:
Company Address:
Tel:
Fax:
RESERVATION:
TRAVEL DETAIL:
Arrival
Date
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31
January
Febuary
March
April
May
June
July
August
September
October
November
December
2004
2005
2006
Time
ETD
ETA
Fight No.
From:
Departure
Date
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2
3
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31
January
Febuary
March
April
May
June
July
August
September
October
November
December
2004
2005
2006
Time
ETD
ETA
Fight No.
From:
SPECIAL REQUIREMENTS:
Any Disabilities ?:
Accommodation:
Double Bed
Two Single Beds
Is This Your First Assembly
Yes
No
PAYMENT:
Date:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
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23
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25
26
27
28
29
30
31
January
Febuary
March
April
May
June
July
August
September
October
November
December
2004
2005
2006
Amount in $:
Bank:
Credit Card:
Master
Visa
Credit Card No.:
-
-
-
Expiry Date:
01
02
03
04
05
06
07
08
09
10
11
12
/
2004
2005
2006
2007
2008
2009
2010
If payment is by credit card,
please supply passport no. :
Bank To Bank Transfer:
Account No.:
102-027627
Routing No.:
121405115
Account Name:
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Phuket
Last Updated :6 April, 2005
