The New York Palace Hotel Registration Form

URALSIB Capital, LLC

November 17, 2010

The New York Palace Hotel Registration Form

The New York Palace Hotel Telephone: + 1

455 Madison Avenue Facsimile: + 1

New York, NY 10022 Email: *****@***com

Please complete and return this form by fax by 18 October 2010. After this date, the hotel will not be able to guarantee availability and reservations will be made on a space availability basis. When making your reservation by ‘phone, please identify the group name “URALSIB Capital” to obtain the special rate.

□ Superior Room (US $ 519 single and double) □Single Occupancy □Double Occupancy

(Specific bed types are not guaranteed but the Hotel will make every effort to accommodate the guests’ needs.) For other room categories/rates, or requests for suites please contact the hotel.

Special requirements:______________________________________________________________________

Arrival Date: Departure Date:

Guest(s) Name: ­­­­________________________________________________________________ _

Company: ­­­­______________________________________ __________________________ __

Address: _______________________________________________________________________ __ _

City: __________________________ Postal code: Country:____________________ ____

Tel: _______________________________ Fax: ____________________________________ __

Email: ___________ _________________ _

GUARANTEE

□ VISA □ MASTERCARD □ AMERICAN EXPRESS □ DINERS CLUB

Card Number: ___________________________________________

Cardholder’s Name: ______________________________________ Expiry Date: _______________