Department of Continuing Medical EducationGuest Hotel Accommodation FormWe are so excited to have you join us for the 59th Annual Pediatric Postgraduate Course.Please complete the following form as soon as possible so that we may secure your accommodation for the course. NOTE:The fields below will be automatically completed using the information in your user profile - please edit the information as needed. Combo Package PurchaseEnter your order number below as shown in your confirmation receipt sent via email. If you don't know your order number, please contact gabriela.martinez@nicklaushealth.org. Order Number * Main Guest Details Prefix * First Name * Last Name * Additional Guests * Will there be additional guests staying with you? Yes No Additional Guest DetailsEnter up to one additional named guest below. First Name Last Name Separate Bills? * YesNo Total # of Adults Total # of Children Booking Details 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 * Leave this field blank
