University of Alberta Individual Room Reservation Request
 
                                 LISTER HALL
 
 
Name (print clearly):
                                                                         M  F
________________________________________________________________________________
     (Family Name)                 (First)                (Middle)     (Circle)
 
Address:                                    Telephone:
________________________________________________________________________________
 
City/Town:                                  Postal Code:
________________________________________________________________________________
 
Province/State                              Country:
________________________________________________________________________________
 
Roommate's Name (if reserving twin):
 
________________________________________________________________________________
                                   (First)                       (Last)
 
 
 
       CHECK-IN TIME IS AFTER 3:00 PM - CHECK-OUT TIME IS BY 12 NOON
 
 
 
Date of Arrival _______________________ Date of Departure_______________________
 
PLEASE NOTE: Full payment is required at the time you send in your
reservation form. Accommodation cannot be guaranteed unless full payment
is received. It is recommended that reservations are made no later
than 14 days prior to arrival. Make cheque or money order payable to
"The University of Alberta".
 *************************
 
Please check method of payment:  __Visa
                                 __Mastercard
                                 __Cheque
                                 __Money Order
 
If paying by Credit Card, please complete the following:
 
Card Number ________________________  Expiry Date ______________
 
Name of Cardholder___________________ Signature of Cardholder___________________
 
 
  Single: _________ nights x $26.88 ($24.00 plus taxes)      = $ _______________
 
    Twin: _________ nights x $35.84 ($32.00 plus taxes)      = $ _______________
 
                        TOTAL ENCLOSED (Canadian Funds)      = $ _______________
 
 
Please return your Application to:
 
Ms. Michelle Hoyle
University of Alberta                              *****************************
Guest Services                                     *  FOR OFFICE USE ONLY      *
44 Lister Hall                                     *  Date Received:__________ *
Edmonton, Alberta, T6G 2H6                         *  Assigned to:____________ *
Canada                                             *  Receipt#:_______________ *
Phone:  (403)492-4281    Fax: (403)492-7032        *****************************
       1-800-615-4807  Email: conference.services@ualberta.ca
 
 
Signature:____________________________         Date:______________________

Return to 3rd CCCC