Accommodation Faxback Booking Form

I am attending the Management Of Type 2 Diabetes: A Brave New World Or The Land That Time Forgot?, and I wish to book accommodation at the following hotel: Please tick your preferred hotel and fax back to 0870 750 1534. If faxing from abroad Fax: 00 44 (0) 1780 757207

All hotels are offered subject to availability. Please book early to avoid disappointment.

Hotel	Proximity to Exhibtion & Nearest Tube	Tick Pref.	Room Type	Rates
Hilton Birmingham Metropole Hotel	On-site			Single £100.00 Double £110.00
Crowne Plaza Birmingham NEC	10 minute walk			Per room £119.00

Your Contact Details

Name
Company Name
Address
Telephone Number
Fax Number
E-mail address

Please fill in for all applications: If required please use an extra sheet of paper

Name of Guest	Type of Room	No. of Nights	Arrival Dates

We need a credit card number to guarantee your rooms; no payment will be withdrawn from this credit card provided that, if you cancel, then you do so within the required cancellation terms. We will send a written confirmation of the rooms booked, cancellation terms and your confirmation reference.

Credit Card Details

Please tick type of card:	Mastercard	Visa	American Express
Delta	Switch	Other

Credit Card Number
Expiry Date
Issue Number (Switch & Solo only)
Signature Please note that your credit card will be used in the event of a no show or late cancellation. Please read the cancellation terms on your confirmation carefully.

All information given will be held strictly for the purpose of this booking and will not be passed to any third party.

**This service is provided by Jigsaw Conferences Ltd. Management Of Type 2 Diabetes: A Brave New World Or The Land That Time Forgot? accepts no responsibility whatsoever relating to the venues or the bookings