UW Conference Housing Reservation Form

XII International Congress on Personal Construct Psychology
(PCP 12th Congress) July 8-July 13, 1997

Important! Please print this form out, fill it out accordingly, and mail it with a check or money order to the specified address! You can print this form by clicking on the Print Icon Button at the top of your browser.

Package Description
A special package has been created to provide campus housing and food services for delegates participating in the PCP 12th CONGRESS. The package includes:

: Five (5) nights of housing
: 12 Meals beginning with Breakfast, July 9, and ending with Breakfast, July 13 (except dinner on July 12).
: Non-refundable reservation fee ($10)
: Applicable sales tax

If you wish to arrange for this package, please complete and return this form along with full payment not later than Tuesday, June 17, 1997. Upon receipt of your reservation and prepayment we will send you a confirmation including a campus map and travel directions. Please read UW's policy on conference housing.

Reservation Information
Please use a separate form for each person's reservation. Please type or print clearly.

Name: __________________________________________ (last, first, middle initial)		FEMALE MALE
Mailing Address: _________________________________________________________
City/State Zip/Country: _________________________________________________________
Telephone: __________________	Facsimile: __________________	E-mail: __________________

Please indicate your room type preference:

Arrival Date: _______________

Departure Date: _______________

Roommate Request
If you select a double room, you may indicate a roommate preference and mutual requests will be honored. If you select a double room and do not designate a roommate, one will be assigned.

Roommate
Preference: __________________________________________
(last, first, middle initial)

Accessibility
Please describe any accessibility accommodation you may require for housing or parking:

_____________________________________________________

Standard Package Package dates are July 8-13, and may not be altered. No credit for fewer days or missed meals. Package rates are per person. Choose one:
Double Occupancy ($199.41 US):	_____________
Single Occupancy ($259.41 US):	_____________
Extra Nights Available July 7 and 13, 1997 ONLY. No meals included. Rates are per person per night. Choose one:
Double Occupancy ($22.00 US) x ______# nights:	_____________
Single Occupancy ($34.00 US) x ______# nights:	_____________
TOTAL ENCLOSED:	_____________

Method of Payment (Check one)

Mail this form to:

Conference Housing & Special Services
University of Washington
McCarty Hall, Box 354471
Seattle, WA 98195

Tel: (206) 543-7634, FAX: (206) 543-4094
You may fax this form if paying by credit card, but then please DO NOT mail an additional copy!

Check (US Funds only) to Univ. of Washington. Please do not fax this form--mail with check in same envelope!
Purchase order. Please attach copy of purchase order, and advise any action required to initiate payment.
VISA MasterCard AMEX	Account Number: ________________________________	Expiration Date: __________
	Authorized Signature: _______________________________________________________