Wet Ice

18 - 20 June 1997

Massachusetts Institute of Technology

Cambridge, Massachusetts

MIT ON-CAMPUS HOUSING REQUEST FORM

 

Name___________________________________________________________________________

Affiliation________________________________________________________________________

Address_________________________________________________________________________

City________________________________ State _______________Zip Code__________________

Telephone___________________________________FAX_________________________________

 

Type of accommodations on-campus:

Single Room

Full Double Room (You and Spouse or Guest) Name of Guest____________________________

Shared Double Room with designated roommate; Roommate Name_______________________

Shared Double Room with undesignated roommate (we will assign)

I am ____ smoker ____ non-smoker ____ male ____ female

Special requirements:__________________________________________

Cot(s) for children between the ages of 6 and 14; Ages_____________________________

 

Arrival Day/Date:________________________ Departure Day/Date_________________________

 

On-campus Housing Fees:

$44 per night/single            $66 per night/full double
$10 per night/cot (ages 6 - 14)
(max 2 cots per double)		            $33 per night/shared double

 

Parking: I will need a parking permit while on campus; $5 per day non-refundable fee.

 

TOTAL FOR HOUSING:$_____________TOTAL FOR PARKING:$_________________

TOTAL ENCLOSED:$_________________

 

METHOD OF PAYMENT: Check or Money Order made payable to M.I.T. is enclosed.

Credit Card Mastercard or Visa (Please check correct card).

Account Number:______________________________Expiration Date__________________

_________________________________________________________________________

Signature (Required for credit card transactions)

 

Please return completed form and payment to: MIT Conference Services Office, Room 7-111, 77 Massachusetts Ave., Cambridge, MA 02139, USA.

Your reservation will be confirmed upon receipt; all rooms assigned on a first-come, first-served basis. Forms with credit card information may be faxed to +1-617-253-7002. For questions, call +1-617-253-1700.