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Reservation Form

Name and Gender Information

First / Given Name

Enter your first name, or given name.

Middle Name

If you have a middle name, please enter it.

Last / Family Name

Enter your last name, or family name.

Gender

Male Female

Select your gender.

Department Name if Applicable

* What is the purpose of your visit?

Enter the Conference Name

Other (please specify)

Address Information

Country

Enter the country for the address e.g.: "Mexico"

Street Line 1

Enter the first line of your address e.g.: "100 Main St"

Street Line 2

Enter the second line of your address if required e.g.: "Apt 23C"

Street Line 3

Enter the third line of your address if required

City

Enter the City or Village name e.g.: "Berrien Springs"

State/Province

Enter the state or province name e.g.: "Michigan"

Zip/Postal Code

Enter the Zip or postal code e.g.: "49103", "49104-0880" or "L8R 2D4"

Phone Number - -

Enter a phone number where you or a family member can be reached.

If address is international, fill in this phone field

Phone Number

Enter a phone number where you or a family member can be reached. Please exclude dashes or spaces

E-mail Address

Enter your E-mail address

Time of Stay

Note Check-in is anytime after 3:00pm on the date of arrival; Check-out is anytime before 11:00am on the date of departure, otherwise, you will incur charges for an additional night

Arrival Date

Please select a Month, Day, and Year

Departure Date

Please select a Month, Day, and Year

Room Preferences

Room type preferred

Will you need internet access during your stay?

Yes No

Special Request Instructions
Please hit the return/enter key at the end of each line to ensure that your message will be formatted correctly on delivery.

Special Request