Name

Address

City, State, Zip

Telephone

Arrival Date

Time

Departure Date

Time

$TBD Deluxe Room — Single or Double

$TBD Premier Room — Single or Double (Limited Availability)

 

Two night’s deposit (room and tax) must be received or assured by credit card below. Reservation must be cancelled 10 days prior to arrival to insure advance deposit refund. Advance deposit will be applied to the final confirmed night of your stay. All rates are subject to 7.25% Bermuda Government Tax and $10.35 (European Plan) service charge per person per day.

Credit Card No.

Exp. Date

AMEX     MasterCard    VISA

Signature

Home | About Us | Contact
Bermuda Urologic | Faculty | Agenda | Information | Hotel | Registration

 

Copyright ©2001. All Rights Reserved.
Last Revised 10-25-08