Miramar Inter-Continental Reservation Form

*Requred Fields

First Name* Last Name*
Email Address* Phone Number*

Number of guests Number of rooms Type of Room
Arriving on the day of Departing on the day of

Many guests stay a day or two, travel to another area of Panama, then return to Miramar Inter-Continental. If this is the case please use this line to indicate the dates of your second stay.
Arriving on the day of Departing on the day of

Additional Comments (Optional):
Travel Agents Only
Agency Name IATA or ARC#
Contact Name Agent E-mail