Name	：
Age	：	10以下 10〜20 20〜30 30〜40 40〜50 50〜60 60〜70 70〜80 80〜90 90以上
Sex	：	Male      Female
E-mail	：
Zip    Post Code	：
Address and country	：
Telephon NO.	：

Home Page title （If you have）	：
Home Page URL	：

Contents of reservation Check in date    Check out date    Number of nights    Number of person Age of children    Room type    Number of dinner and breakfast    fax number Feel free to write some message

NB: This application form does not confirm or guarantee your reservation.
Upon our receipt of this form, we will contact you to confirm your accommodation.

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