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12th Nat'l KP Hosp Med Conf - Physician Registration

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: $350.00

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

Kaiser Region:

Non-Kaiser Facility or Practice*:

i.e. Group Health Cooperative. Please enter "NA" here if you are a Kaiser affiliate.

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

Breakout Session Selections

Breakout Session I:

Cardiology
Critical Care
Infectious Disease

Breakout Session II:

Cardiology
Critical Care
Heme-Onc

Hotel Reservation

No Hotel Required:

Check Here if you do not wish to reserve a hotel at this time.

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

Room Type:

Arrival and Departure dates need to be entered in field. Room reservation cannot be confirmed without this info.

# 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:

Guest 4:

Features