Global IPv6 summit in Korea July 5~7, 2004 Lotte Hotel Seoul·Jamsil, Korea Reservation Form
(Only for participants in summit)
  Surname _ _ _ _ _ _ _ _ _ _ _ _
  First Names _ _ _ _ _ _ _ _ _ _ _ _ _ _
  Title: Mr/Miss/Mrs/Other _ _ _ _ _ _ _ _ _
  Company Name _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
  Telephone Number _ _ _ _ _ _ _ _ _ _ _ _ _ _
  Fax Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
  Arrival Date _ _ _ _ _/ _ _ _ _ / _ _ _ _ _
  Departure Date _ _ _ _ _/ _ _ _ _ / _ _ _ _ _
  Total Nights Stay _ _ _ _ _ _ _ _ _ _ _ _ _ _
  No of guests _ _ _ _ _ _ _ _ _ _ _ _ _

Accommodation Room Type
  DELUXE TWIN/DOUBLE rate : 212,960 per night(approximately 177 USD)

Method of Payment
  Visa/ MasterCard / AMEX/ Diners / Other _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
  Credit Card Number - - / - - / - -
  Start Date (Where Applicable) _ _ _ _ _ _ / _ _ _ _ _ _
  Expiry Date _ _ _ _ _ _ / _ _ _ _ _ _
  Name as on Credit Card _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
  Billing Address of Credit Card _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
  Country _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
  POST CODE _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
  Signature _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _