ICTCS01: Reservation Form for rooms at Villa Gualino


    First Name:

    Last Name:

    Institution:

    Mailing Address:

    Town:

    Post Code:

    Country:

    email:

    telephone:

    fax:

    Arrival date:

    Departure date:

    Room (check one, please):

    • single
    • double


    Credit card:
     

    • type (visa, mastercard,.....):

    • valid card number:

    • expiration date:

    • holder's name (as it appears on the card):

    • holder's signature:

      •  
                                                                                                                    Signature