La Escapada

Reservation Form

Please fill and send this form completly:

1- Personal Information

Family Name:

First Name:

Organization:

Title/Position:

Mailing Address:

Phone:


Country Code	City Code	Number

Fax:


Country Code	City Code	Number

E-mail:

Arrival Date:		Arrival Flight:
Departure Date:		Departure Flight:

2. Options:

Choose Room type and Hotel choices

May - November
Rooms $55.00 per nights

December - April
Rooms $70.00 per nights

Cash (Only in Panama)