Print this Form, fill it out and
fax it to the Park Lodge Hotel
(+61 2) 9318 2513
PLEASE PRINT YOUR
DETAILS CLEARLY.
Fields marked in bold text are
required fields
Title:
Mr
/ Ms ___________
First
Name:
_______________________
Last
Name:
_______________________
Home
Ph:
(______)________________
Work Ph:
(______)________________
Email:
_______________________
Fax:
(______)________________
Country:
_____________________________
Day
Month
Year
Arrival Date:
_______ ______
______
Arrival
Time:
___________AM
/ PM
(approx)
(at hotel)
Day
Month
Year
Depart
Date:
_______ ______
______
Please be aware
of date and time changes when
crossing the international date
line. We suggest you
check your ticket
to
avoid problems on arrival.
Number
of Occupants:
_________
Number
of Beds required:
_________
(Children 12 years of age and
under are free in parents room)
Room
Preference: Please
tick/check along side your
preferred room ( or number your
selections in order of
preference if you have more than
one preference)
Payment details are required
ONLY if you wish to book (and
hold) the room.
Credit
card:
_______________________
Card
Number:
_______________________
Name on
Card
_______________________
Expiry
date:
__________
(mm)
/ _________
(yy)
Please
reply/confirm by email.
(my email
address is above)
Yes
/ No
Please
reply/confirm by fax.
(my fax
number is above)
Yes
/ No
I understand the Charge and Cancellation Policy for my stay, which is available
here. The
Charge and Cancellation Policy will also be on my booking confirmation.
Signature of card holder
__________________________________________