Accomodation Online Payment: Step 1 of 3

Your Details

	Title
	First Name
	Surname
	Email Address
	Hospital Name
	Department
	Position Held
	Address

	Town/City
	Postcode
	Country
	Telephone


Accommodation Options

	Hilton Deluxe Room	£163.33 (£139 + VAT) *
	Double Occupancy Supplement	£23.50 (£20 + VAT) *
	* All Prices are per night and include breakfast.
	Dates Required:
	Saturday 14th June 2008
	Sunday 15th June 2008
	Monday 16th June 2008

Additional Information

Please enter any special requests here.


Credit Card Details

	Card Type
	Card Number
	Start Date	/
	Expiry Date	/
	Issue Number	(Switch / Solo)
	Card Verification Code	(More Information)
	Name On Card

Endorsed By: