RESERVATION FORM PIXEL – "The Future of Education", 11 – 12 June 2015 Attendee’s last name and name: _________________________________________________________ e-mail: _________________________________________________________ (please write in capital letters) Check-in date:_ _/_ _/_ _ _ _ Check-out date: _ _/_ _/_ _ _ _ N. of rooms: ______________________ Double single Use room  Double room  Twin room  Triple room  Accompanying name: _______________________ Accompanying name: _______________________ Special requests (to be confirmed by the hotel according to availability):________________________________________ Room rates Double room for Single Use Twin/Double Room Triple Room Before 1 March 2015 Before 30 April 2015 Until 7 June 2015 € 135,00 € 147,00 € 177,00 € 145,00 € 157,00 € 187,00 € 165,00 € 170,00 € 195,00 Above mentioned rates are intended per room per night. Rates are inclusive of buffet breakfast and VAT. City tax of € 4.00 per person per night not included. These special rates are dedicated to "ICT for Language Learning" event attendees only. ____________________________________________________________________________________ GUARANTEES AND PAYMENT: Attendees can confirm for their reservations with  Credit card details (guarantee only, no advance charge – direct payment at check-out): Credit card number:________________________________________ Expiration date:______________ Cardholder name:_____________________________________________________________________ Owner’s signature:____________________________________________________________________  Full prepayment with bank transfer (Please be so kind to put the attendee/s name/s on the bank transfer reference and provide hotel with a copy via e-mail or fax): GRAND HOTEL MEDITERRANEO BANK NAME: Cassa di Risparmio di Firenze Agenzia 5 IBAN: IT51T0616002805000003079C00 SWIFT: CR FI IT 3F XXX CANCELLATION POLICY: Reservation can be cancelled without penalty up to 7 days prior to arrival. Cancellations out of the mentioned terms will be charged with 100% penalty as well as NoShows. IMPORTANT:  This reservation form must be sent within 7 June 2015a. After this date, availability of rooms is not guaranteed.  Please be so kind to send this form by e-mail to [email protected] or by fax +39 055 679560  Please fill one form per each room needed. . Lungarno del Tempio 44 50121 Firenze Tel. +39 055 660241 Fax. +39 055 679560 Sito Internet: iwww..hotelmediterraneo.com email: [email protected] Di proprietà Montecarlo Immobiliare SpA Sede Legal Lungarno del Tempio 44 50121 Firenze Capitale Sociale euro 1.000.000 C.C.I.A.A di Firenze CF P.Iva ed Iscrizione Registro Imprese: 00434210480