Personal
Contact Information
First
Name: *
Last Name: *
Address:
*
Zip Code: *
City:*
Country:
*
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Other
E-Mail:
*
*
all fields above marked
with an asterisk are required.
Telephone:
(
)
Mobile
Phone:
(
)
Fax:
(
)
Country
Code - City
Code -
Number
Hotel
Reservation Information
Room Preferences:
----- Please Select -----
Room
1 Room Apartment
2 Rooms Apartment
2 Rooms
Apartment + child room
Deluxe Apartment
Any Space Available
Extra Bed:
Yes
No
Number of Rooms:
1
2
3
4
5
6
7
8
9
10
Number of Adults:
1
2
3
4
5
6
7
8
9
10
Number of Children:
0
1
2
3
4
5
6
7
8
9
10
Check-in Date:
Day
1
2
3
4
5
6
7
8
9
10
11
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15
16
17
18
19
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21
22
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24
25
26
27
28
29
30
31
Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
2005
2006
2007
2008
2009
2010
Check-out Date:
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
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24
25
26
27
28
29
30
31
Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
2005
2006
2007
2008
2009
2010
Transfer
Services
Do you require a transfer from/to the Sai Rougn Residence?
Phuket Airport:
Yes
Arrival Date:
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
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20
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25
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27
28
29
30
31
Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
2005
2006
2007
2008
2009
2010
Flight No:
Time:
Departure Date:
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
2005
2006
2007
2008
2009
2010
Flight No:
Time:
Phuket Bus
Station:
Yes
Arrival Date:
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
2005
2006
2007
2008
2009
2010
Time:
Departure Date:
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
2005
2006
2007
2008
2009
2010
Time:
Other Place:
Yes
Arrival Date:
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
2005
2006
2007
2008
2009
2010
Time:
Your
Meeting Point:
No thank you, I will arrive on my own.
Method
of Payment
You will pay
by
Cash
Visa Card
Master Card
Bank Transfer
Special
Request & Comments: