Meetings by Design

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Residents (Monday or Tuesday only)

Please note: We will need a credit card in order to hold your hotel reservation. Unless you specify a different credit card type, number, and expiration date in the "Special Request" section below, we will use the credit card information you provide at checkout to guarantee your hotel room.

Our Price: $100.00

Registrant Information

Pre-Title:

First Name*:

Middle Initial:

Last Name*:

Suffix:

For "Other" suffix, please note in Remarks section below.

Post-Title:

For "Other" post-title, please note in Remarks section below.

Badge Name:

Enter nickname or leave blank if same as above

I will attend on:

Kaiser Region:

Facility City:

Facility State:

Remarks:

*Enter remarks or custom post-title here.

How did you hear about this meeting:

For "Other," please note in Remarks

Hotel Reservation

Check-In Date:

Use format MM/DD/YYYY; date you will arrive

Check-Out Date:

Use format MM/DD/YYYY; date you will depart

Bed Request:

Number of beds - Enter 1 or 2; hotel cannot guarantee

# of Rooms:

Enter the number of rooms you are requesting

Special Request:

*Enter special room requests. Indicate if reserving more than one room, or if sharing a room with another attendee. Hotel cannot guarantee special requests.

Full Guest Names In This Room

Guest 1 or Self:

Guest 2:

Guest 3 Age:

Enter age if under 18

Guest 4 Age:

Enter age if under 18

Features