First name *
Last name *
Address
Your Country :
Arrival Date * Day    Month    Year 
Departure Date * Day    Month    Year 
Number of persons *                       
Number of rooms *   
Room occupancy Double   Single     Triple  (please enter a number)
Room type Double bed        Twin beds  (please enter a number)
If not included in the package, VICTORIA Hotel transportation        Yes          No
If yes, please give more details
Comments
Receive the Victoria Newsletter          Yes          No
Receive the Chau Doc Brochure       Yes          No
      Your reservation will be replied by e-mail within 48 hours