ROOM RESERVATION FORM

THE INTERNATIONAL CONSENSUS CONFERENCE
ON THE FIGHT AGAINST CERVICAL CANCER
March 18-22, 2000

For hotel reservations at the DRAKE HOTEL, please fill out the form below and send it DIRECTLY to:
The DRAKE HOTEL, East Walton Street, Chicago, Illinois 60611, USA
FAX: (312) 787-2549, Telephone: (312) 787-2200, Outside Illinois (1800) 553-7253.

DO NOT SEND THIS FORM to the Conference Office.

Room Rates: Single or double: 129.00 (plus tax)


Please reserve accommodations for (Print or Type)
Last Name:
 ______________________________
First Name:
______________________________
       
Phone Number:
______________________________
Company:
 ______________________________
       
Arrival Date:
______________________________
Departure Date: :
 ______________________________
   
Street:
 _____________________________________________________________________________
       
City:
 ______________________________
State:
 ______________________________
       
Postal Code:
 ______________________________
Country:
 ______________________________
       
Sharing Room with:
 ______________________________
No. of Persons::
 ______________________________
       
Credit Card Type:
 ______________________________
Credit Card #:
______________________________
       
Expiration Date:
 ______________________________
Signature:
______________________________

SEND WRITTEN CONFIRMATION: YES NO
ACCOMMODATIONS WILL NOT BE CONFIRMED WITHOUT A CHECK OR CREDIT CARD GUARANTEE FOR THE FIRST NIGHT'S DEPOSIT. YOU WILL BE CHARGED FOR THE FIRST NIGHT IF RESERVATIONS ARE NOT CANCELLED 48 HOURS PRIOR TO ARRIVAL.

PLEASE CHECK PREFERRED ACCOMMODATIONS:

SINGLE DOUBLE/1 BED DOUBLE/2 BEDS NON-SMOKING

 

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