Workshop on Positron Emission Mammography
                       1 and 2 July, 2002
                        Lisbon, Portugal
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             RESERVATION FORM  -  HOTEL AMAZONIA
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FIRST  NAME: _____________________________________________________

INSTITUTION: _____________________________________________________

    ADDRESS: _____________________________________________________

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  FACSIMILE: _____________________________________________________


  (TYPE AN  "X"   IN THE SPACES CORRESPONDING TO YOUR CHOICES)


 Please book me a  ___ Single Room   (70 Euro/day)

                   ___ Double Room   (80 Euro/day)

                                     (breakfast included)

 Date of arrival: 2002/____/___  Date of departure: 2002/____/___


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           Expiry date: ____/___    (e.g. 11/00)

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 PRINT and send by FAX to    HOTEL AMAZONIA
                             Travessa da Fabrica dos Pentes, 12 a 20
	                     1250-106 Lisboa, Portugal

       Fax: +351-21-387-9090    Tel: +351-21-387-7006
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