Hotel Reservation

2004 VMIC CONFERENCES September 29 - October 2, 2004 APPLICATION FOR HOTEL ACCOMMODATIONS - Waikoloa Beach Marriott Hotel Reservations request must be received by September 7, 2004 Waikoloa Beach Resort Marriott 69-275 Waikoloa Beach Drive Waikoloa, Hawaii 96738-5711 Fax 808-886-7852 Phone 808-886-6789 Reservations 888-924-5656 Indicate VMIC or IMIC Assoc. Do NOT send with Conference Registration Card. Send directly to the Hotel.
Name: (type or print): Last_______________________ First_______________________ Middle_____________________
Firm/University
Address:
City/Country/Zip:
Phone:			FAX:			Email
Arrival Date: ________________ Departure Date: ________________
Room type: Single___________________					Double___________________	Double-Double___________________________
Reservations must include first night's deposit in the form of a credit card of check. Check in time is 3 P.M.
Company				Credit Card.
Please circle one:	MC	VISA	AMX	CB	DC	OTHER
Card Number: ________________________________________ Expiration Date:_______________