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Hotel Reservation Form

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TO: Department of room reservation, Sakura Hotel Maebashi

FAX: +81-27-221-5768    

Hotel Reservation Form

2013 International Conferences on AMT-BHI

(Please send this form to us by E-mail or fax after you complete it.)

Reservation Date:


Nationality                    Passport No.              

TEL               FAX                  

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)

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