MEETING DATA
Today's Date
Name Work Phone FAX E-mail
Meeting Name
Location Preferred Date -- mm/dd/yy Previous Registration Fee? Amount Assessed Are there off-site events associated with this meeting? Yes No What type of events Which nights
Would you like registration materials assembled and mailed by us? Yes No If yes, who is our contact for approval of materials Would you like nametags for the meeting? Yes No Would you like on-site assistance? Yes No Method of Payment
Mastercard Visa American Express Credit App: Check
Hotel Preference
Hotel/facility of any previous meetings.
Previous sleeping room rate.
Previous date of meeting -- mm/dd/yy Preferred location of meeting
Close to Airport Close to Restaurants Downtown Other
If marked "other" above, please specify
Payment Options
Individual Pays Own Room Organization Pays for Sleeping Rooms
Any Handicapped Individuals? Yes No Names of Handicapped
Would you like any special transportation arrangements (Busses/vans)?
Yes No
