Radiology International Inc.

                    Consistently High Standards

HOTEL RESERVATION FORM - Radiology in China 2006

Enclosed is our payment in the amount of $1,000 per room representing deposit for the Radiology in China Conference. Cancellations of land arrangements will result in a $100 per person administrative fee in addition to penalties that may be imposed by the hotel and ground operator. There will be no refund on cancellations received on or after March 15, 2006. By completing this form, we acknowledge and accept all the terms and conditions of the conference.

E-mail Address:
Full Name:
Additional Persons:
Address:
City, State/Province - Postal Code - Country

Please indicate the hotel accommodations you prefer: (U.S. Funds Only)

Room Rates: 
   Physician Rate Single Room: $3,045.00       Additional costs for 2nd person: $1,795.00
   

Supplements for Deluxe rooms, Horizon Club and Bund View rooms are available by contacting Sylvia, Claudia or Denise at Globe Travel.

Rates Include Breakfast, Taxes and Transfers

Offline Credit Card or Check Payments.

If you wish to pay by check or money order, please print and mail along with your check or money order made payable to:
Globe Travel Service
888 Farmington Avenue, Bristol, CT USA 06010
1-860-584-0517
1-800-942-4080 (Toll Free in the U.S.A.)


If you wish to pay by credit card, please print this form and mail or fax to:
Globe Travel Service
888 Farmington Avenue, Bristol, CT USA 06010
(Fax number: 1-860-585-6364) 1-860-584-0517
1-800-942-4080 (Toll Free in the U.S.A.)