Hotel Reservation Form

Hotel Reservation Form
Please fill in this form and return it to the hotel of your choice by fax or email no later
than April 24, 2014.
First name:
Tel:
Last name:
Fax:
E-mail:
☐ Maritim Parkhotel Mannheim
☐
Booking Code: Stochmod
(84 € Single / 115 € Double)
10 minutes
15 minutes
Friedrichsplatz 2
68165 Mannheim
Tel: +49 (0) 621 1588-834
Fax: +49 (0) 621 1588-800
info.man@maritim.de
www.Stochmod2014.de/Maritim
Kurpfalzstuben
Booking Code: Stochmod
(65 € Single / 85 € Double)
10 minutes
10 minutes
L14, 15
68161 Mannheim
Tel: +49 (0) 621 150392-0
Fax: +49 (0) 621 150392-90
makurpfalzstuben@aol.com
www.Stochmod2014.de/Kurpfalz
☐ Zur Alten Brücke
Booking Code: Stochmod
(119 € Single / 139 € Double)
45 minutes
Obere Neckarstrasse 2
69117 Heidelberg
Tel: +49 (0) 6221 73913-0
Fax: +49 (0) 6221 73913-20
info@hotel-zur-alten-bruecke.de
www.Stochmod2014.de/AlteBruecke
Room rates are per night incl. breakfast and are subject to change without notice. Please note that all rooms are
non-smoking and will be allocated on a first-come, first-served basis.
☐ Single room
Room type
Arrival date
Departure date
☐ Double room
Approx. arrival time
Approx. departure time
To confirm and guarantee your reservation, we kindly ask you to fill in your credit card
information. Please note that your invoice must be settled upon departure.
☐ Mastercard
Card no.:
Signature:
☐ Visa
☐ American Express
☐ Other:
Expiry date:
Security no.: