Club Bali Mirage Reservation Form

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Check in date  January February March April May June July August September October November December 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 201020112012 Arrival flight #  Check out date  January February March April May June July August September October November December 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 201020112012 Depart flight #  Airport transfer  No, I do not require any transport to hotel.   Yes, please arrange transport to hotel at US$ 20.00 /way/car (max. 2 person). Additional US$ 5.00 surcharge apply for arrival flight after 08.00 PM

Desired Room Accommodation

No. Adults - required No. children: Child(ren) age(s): No. Rooms - required Room requested All-Inclusive Twin All-Inclusive Single Deluxe Romantic Suite Preferred bed type Double (King or Queen) Twin  (2 single beds)

Your name and how to contact you

First Name - required Nationality Last Name - required Phone (w/ area code) E-mail - required Mobile (w/ area code) How did you learn about BaliHotels.com ? Please select one Google Bing Yahoo Other search engine ------------------------------ Link from other site Friend Forum Guide Book Just type BaliHotels.com

Notes:   All Rates Inclusive of 21 % Gov't Tax & Service Charge. No Hidden Charges All reservations subject to room availability Reservation not confirmed without Booking Confirmation Code Rates subject to change without notice   Hotel Cancellation Policy; Club Bali Mirage will charge:   50% total room night's stay for no show One nights stay for cancellation notice given less than 72 hours prior to scheduled arrival 50% of total night's stay for cancellation notice given less than 7 days prior to scheduled arrival (25 Dec - 05 Jan)     Comments, requests, questions

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