| TO: Department of room reservation, Sakura Hotel Maebashi
Hotel Reservation Form
2013 International Conferences on AMT-BHI
（Please send this form to us by E-mail or fax after you complete it.）
Nationality Passport No.
Check-in Date (Month/Day/Year) Arrival Time :
Check-out Date (Month/Day/Year)
☐ Smoking ☐ Non-Smoking * Non-Smoking rooms are based on availability.
Room Type / Number of room(s)
1 Guest/room ☐ Single ☐ Twin ☐ Double room(s)
4,500 (JPY) 5,500 (JPY) 5,500 (JPY)
2 Guests/room ☐ Twin ☐ Double room(s)
7,000 (JPY) 7,000 (JPY)
Payment method ☐ Cash ☐ Credit Card (Credit Card Company: * e.g.：VISA）
* The above discount prices are only applied to the attendees of 2013 International Conferences on Active Media Technology (AMT) and Brain Informatics health.
* The reservation deadline is September 28, one month before the conference. There is a case to decline in no vacancies.
* This form is not suitable for the applications through travel agents or Internet.
* Above prices include the expense (plus tax) of room and breakfast.
* Check-in could be made after 3:00 p.m., and please check-out before 11:00 a.m.
* Earlier check-in and delayed check-out will lead to other costs.
* The written private information will be used only for the room reservation.
* Contact: Maebashi Sakura Hotel Front: Mr. Shinada and Mr. Tobita
Address: 2-16-1, Hommachi, Maebashi-City, Gunma 371-0023 Japan
（Walking to the conference hall Terrsa from Maebashi Sakura Hotel takes 6-7minutes）
Home Page: http://www.maebashihotel.com/access/