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 __________________________________________