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Hotel Only Full Payment 7 Nts (Deluxe Ocean Front)

Our Price: $3,187.00

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:

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

Cancellation Policy*:

_I certify that I have read and understand the Cancellation Policy for the 2010 Kaiser Permanente National Pediatric Conference. I accept responsibility for purchasing optional Trip Cancellation Insurance (recommended) to protect against possible financial loss in the event of a last-minute cancellation of my hotel package.

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

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 1 Age:

Enter age if under 18

Guest 2:

Guest 2 Age:

Enter age if under 18

Guest 3:

Guest 3 Age:

Enter age if under 18

Guest 4:

Guest 4 Age:

Enter age if under 18

Description

$1,718.00 Hotel + 450.00