ATTENTION TO: Ms. S. Nomura
ADDRESS: 16-1, Tenjin 1-chome, Chuo-ku, Fukuoka 810-8584 Japan
FAX NO.: +81-92-781-7198
 

Family Name:	Mr./Ms.
First Name:
Affiliation:
Address:
City, (State), Postal Code, Country:
Arrival Date:
Departure Date:
TYPE OF ROOM  (PLEASE TICK):	[   ] Single: ¥10,500  [   ] Twin: ¥ 9,975  [   ] Twin/Single Use ¥15,750
Date:
Signature:

 

Please return this form directly to HAKATA TOKYU HOTEL via fax (+81-92-781-7198) by 1999-02-07.