NANOTUBE-99 HOTEL REGISTRATION FORM July 24-27, 1999 ==================== Group Code: NWN9 ==================== East Lansing RAMADA INN 1100 Trowbridge Rd. East Lansing, Michigan 48823-5222, USA Phone: 517-351-5500; Fax 517-351-5509 Room Rate: $53 plus 11% tax per night PLEASE COMPLETE ALL INFORMATION and fax to 517-351-5509: Last Name: _______________________ First Name: ____________________________ Address: _____________________________________________________________________ ______________________________________________________________________________ City State Zip Country Phone: (_______)_________________ Fax ( ________) ____________________ Arrival Date: __________ Arrival Time: __________ Departure Date: ____________ [ ]Request complimentary pickup at Lansing airport: Airline and Flight no.__________ Number of Persons: ____ Sharing Room With: __________________________________ Circle One: Smoking Non/Smoking Circle One: One King-size bed Two double beds A one-night deposit is required and must accompany this request for a reservation to be made. Please indicate type of payment below. [ ] Enclosed is a check or money order drawn on a US bank for $ _________ [ ] Credit Card Information authorizing my reservation to be charged in the amount of $_________ Circle type of Credit Card: AmericanExp. Visa MasterCard CB/Diners Discover ________________________ ___________________________ ____________ Name of Card Holder Credit Card Number Expiration Date Signature: _________________________________ Date:______________ Failure to cancel your reservation 24 hours prior to arrival will result in forfeit of deposit.