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GENERAL INFORMATION
First Name:*
Last name:*
Title:
Company Name:
Street Address:
P.O. Box:
City:
State/Province:
ZIP Code:
Country:
Daytime Phone:
FAX:
E-mail Address:*
How did you hear about us?:*
Would you like to receive special email promotions from us?
Yes.
No.
Date by which proposal must be received:
By which method should we respond?
- Please select from the list below -
phone
fax
e-mail
Meeting / Event Information
Name of meeting/event:
Brief description of meeting/event/function:
Preferred dates of meeting/event:
Are these dates flexible?
Yes.
No.
Your alternate dates, if any?
Would you like our staff to handle
registration services for your conference?
Yes.
No.
AccomModation Information
Arrival Date*
Departure Date*
Sleeping Room Block (Hotel):
Date
Singles
Doubles
Suites
1.
2.
Sleeping Room Block (Dorm):
Date
Singles
Doubles
Linen Package
No Linens
1.
2.
Meeting Room Block:
Date
Start Time
End Time
No. of People
1.
2.
Meeting Room Setup Preference: (please check all that apply)
Classroom
Conference
Theater
U-Shape
Audio Visual Equipment please check all that apply)
Whiteboard
Copy Services
Microphone
Easel w/Flip chart
Cassette Recorder
Data Projector
VCR
35mm Slide Projector
Audio Amp Devices
Overhead Projector
Video Monitor
Speaker Phone
Podium
Paper /Pencils
Computer Terminals
Transparencies
Slide Trays
Laser Pointer
Are there any other requirements or information that you'd like us to know about your meeting or event?
Billing information if different from general information:
Additional comments:
