The 2nd Asia - Pacific Regional Forum on Sustainable Smart cities and e-Government

During period on 29 August - 2 September 2016 Hotel Reservation Form

(Confirmation letter will be sent back when we receive the detailed information of credit card guarantee)

Attention: Khun Chinorot Khaesawang /Grand Mercure Phuket PatongTel: (66 ) 76 231999 Fax: (66 ) 76 231998E-mail: H8109-RE@ACCOR.COM and H8109-RE1@ACCOR.COMGuest Details:

Number of guests: ……………person (s)

1. Mr. / Ms. / Mrs. Last Name: …………………………….. First Name: ……………………………..2. Mr. / Ms. / Mrs. Last Name: …………………………….. First Name: ……………………………..

Company Name: ……………………………..……………………………..………………………………………

Address: ……………………………..……………………………..………………………………………

Tel no. : ……………………………..……………………………..………………………………………

E-mail: ……………………………..……………………………..………………………………………ACCOMMODATION RATES (Inclusive of breakfast and internet wifi)Room rate Room Type Single / Double Occupancy Superior room ( ) THB 3,000 net THB per room

Extra bed ( ) THB 1,500 net THB per room

Arrival Date : ………………………………. Flight No.: ……………………… Arrival Time: ………………………

Departure Date: ……………………………...… Flight No.: ……………………… Departure Time : ……………..…

TRANSPORTATION: If you require transportation from the airport please complete the following;( ) Private car pick up from Airport at Baht 1,500 net /car/way (max 2-3 persons) ( ) Private van pick up from Airport at Baht 2,000 net /van/way (max 4-7 persons)

All reservation is required credit card for guarantee:Credit Card Company: ………………………………………….………………………………………….………….…….Name of Card holder: ………………………………………......………………………………………….………….……

Card No.:…………………………………………………………………………………………………….….

Expiry Date: ……………………………………………………..………………………………………….…….Security code: ………………………………………………...…………………………………………………….... Signature: ……………………………………………………....…………………………………………… Remarks: - Check in time at 14.00 hrs. And check out 12:00 hrs.- The above rates are inclusive of 10% service charge, 1% applicable provincial tax and 7.7 %applicable government tax (total 18.7 %)

- The above rates are valid for the above for participant of ITU attending from period on 29 August - 2 September 2016 only. (The main event will be held at Le Meridien Phuket Beach Resort)- The space is subject to availability- Bookings will only be confirmed with a credit card guaranteed- The last date for fellowship application is 29 July 2016