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Rodrigues Romania Russia Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Paul and Amsterdam Saint Pierre and Miquelon Samoa (America) Samoa (Western) San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Somalia South Africa Spain Sri Lanka Sudan Suriname Swan Islands Swaziland Sweden Switzerland Syria Tanzania Taiwan Tajikistan Thailand Togo Tokelau Tonga Trinidad and Tobago Tristan da cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States of America Uruguay Uzbekistan Vanuatu Vatican Venezuela Viet Nam Virgin Islands (US) Virgin Islands (British) Wake Island Wallis and Futuna Western Sahara Yemen Yugoslavia Zaire Zambia Zanzibar Zimbabwe (as in Passport) Country of Residence:   Please select one Adelie Land Afghanistan Alaska Albania Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Ascension Australia Austria Azerbaijan Azores Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Canary Islands Cape Verde Cayman Islands Central African Republic Chad Chagos Islands Chile China Christmas Island Cocos Keeling Islands Cook Islands Colombia Comoros Congo Costa Rica Cote d'Ivoire Croatia Crozet Archipelago Cuba Cyphrus Czech Republic Diego Garcia Djibouti Denmark Domiica Dominican Republic Easter Island East Timor Ecuador Egypt El Salvador Equatorial Guinea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guiana Guinea Guinea-Bissau Guyana Honduras Hong Kong Hungary Haiti Hawaii Howland Island ICAO Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jarvis Island Johnston Island Jordan Kazakhstan Kenya Kerguelen Kiribati Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Madagascar Madeira Malaysia Malawi Maldives Mali Malta Marshall Islands Marion Island Martinique Mauritania Mayotte Mauritius Mexico Micronesia Midway Islands Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Marianas Norway Oman Pakistan Palau Palmyra Island Panama Papua New Guinea Paraguay Peru Philippines Phoenix Islands Pitcairn Poland Portugal Puerto Rico Qatar Reunion Rodrigues Romania Russia Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Paul and Amsterdam Saint Pierre and Miquelon Samoa (America) Samoa (Western) San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Somalia South Africa Spain Sri Lanka Sudan Suriname Swan Islands Swaziland Sweden Switzerland Syria Tanzania Taiwan Tajikistan Thailand Togo Tokelau Tonga Trinidad and Tobago Tristan da cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States of America Uruguay Uzbekistan Vanuatu Vatican Venezuela Viet Nam Virgin Islands (US) Virgin Islands (British) Wake Island Wallis and Futuna Western Sahara Yemen Yugoslavia Zaire Zambia Zanzibar Zimbabwe (Where are you now?) Important!! Pls furnish complete email address so that our reply could reach you RESERVATION DETAILS Please select the hotel and room type you would like to reserve. Types of rooms  required  ---- Please select room-type --- Standard room Superior room Deluxe room Suite Type of Bed select Single Twin Double Triple Number of rooms required: 1 2 3 4 5 6 7 8 9 10 11 12 Number of persons required: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Number of Child: 0 1 2 3 4 5 6 Ages of Children: Extra Bed Required Yes No Indicate here if more than 1 type of rooms are required Please also furnish names of the guests for the additional rooms Date check in  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 2006 2007 Date check out  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 2006 2007 FLIGHT INFORMATION Flight name and no. (Arrival) Time of Arrival : Flight name and no.(Departure) Time of Departure : Indicate here for any special request Please take a moment to let us know from where you get to know our site: From Search Engine ----- Altavista ----- Excite ----- Hotbot ----- Google ----- dmoz.com ----- AOL ----- Infoseek ----- Lycos ----- Yahoo From Sawasdee.com From Pattaya.com From Bangkokpost web From other web site From printed media From friend's recommendation

To payment your reservation, please print out this form and fill in all the information required with your signature and fax this form to +66 (0) 3824 8199 Attn : Reservaiton Dept.

Remark: You will be informed of the status of your reservation within 24 hours after this form has been submitted. Thank you and we wish you a pleasant journey. For further information please contact us at rsvn@newdaynightpattaya.com

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