APSEC '99 Hotel Reservation Form


Please type or print this form and return it to the following address. 
It must be received no later than Nov. 12th. Otherwise, reservation depends 
upon room availability at the time your request is received. 
For Japanese, please use Japanese characters (KANJI).

        TO:  Japan Travel Bureau, Takamatsu Branch
             7-6 Kajiya-machi, Takamatsu, 760-0028 JAPAN
             FAX: +81-87-821-2177  TEL: +81-87-851-3055


Full Name:  __________________   __________________    __________
              Last/Family            First             Middle

Title:	(  ) Dr.	(  ) Mr.	(  ) Ms.

Institution / Company: _________________________________________________

                       _________________________________________________

Address: _______________________________________________________________

         _______________________________________________________________
 
Zip Code: ________________________     	Country:  ______________________

Phone:	 +________________________      Fax:	 +______________________

e-mail:   ________________________________	Registration #: ________


Hotel Accommodation

Hotel Selection:   (   ) A     (   ) B     (   ) C

(   ) Single Room	(   ) Twin Room [ ______________________________ ]
                                         Name of person sharing the room

Check-in Date  12/___  Check-out Date   12/___ 	for  ____  Night(s)
      	    Month/Date	      	     Month/Date

Deposit
One night deposit is required for hotel reservation. The deposit will be 
used for your room charge. If you do not stay in the hotel, the deposit 
will not be refunded.


Room Rate (including breakfast, service charge and tax)

   HOTEL NAME                          Single       Twin 
-----------------------------------------------------------------
A  TAKAMATSU KOKUSAI HOTEL             10,000 yen   19,000 yen
B  TAKAMATSU WASHINGTON HOTEL PLAZA     9,000 yen   17,000 yen
C  OKURA HOTEL TAKAMATSU                7,500 yen   12,200 yen
-----------------------------------------------------------------
                                                      Room/Night

Payment of Deposit

Please pay the hotel reservation deposit by credit card to the hotel.
(  ) Master Card	(  ) Visa	(  ) Diners	(  ) American Express


Card Number:  ___________________________    Expiration Date:  ___ / ____
                                                              Month/Year

Card Holder's name (Please Print):  _________________________________


Signature: ______________________________      Date:  _____ / _____ / 1999
                                                       Month/ Day