Department of Continuing Medical EducationAccommodation FormPlease complete the following form as soon as possible so that we may book your accommodation for the course. Main Guest DetailsThe fields below will be automatically completed using the information in your user profile. You can edit any of the information as needed. Please note your booking details will be sent to the email provided in this form, should you prefer this information go to another email, make sure to edit this information. Prefix * First Name * Last Name * Additional Guests * Will there be additional guests staying with you? Yes No Sharing WithEnter up to one additional named guest below. First Name Last Name Separate Bills? * YesNo Total # of Adults Total # of Children Room Type * - Select -Double (2 Queen Beds)Single (1 King Bed) Notes/Special Requests Enter any additional notes here for the hotel staff Address * Telephone Number * Email Address * Additional Comments or Notes Use this space to provide any additional details for NCHS Staff Disclaimer & Additional InformationPlease be aware that there may be additional fees not covered through our booking for additional guests. Additional charges and incidentals are the responsibility of the guest unless otherwise arranged.By entering my name below I attest to having read the disclaimer above, that the information I entered in this form is correct, and that I will update CME staff immediately should any changes be needed. Name * Requested Arrival Date Month MonthMar Day Day2122232425 Year Year2024 Leave this field blank
