Adam's Mark Hotel Conference
Type of Room No. of Rooms Rates
Single (1 person) _____________ $94
Double (2 people) _____________ $94

The above rates are subject to applicable state and local taxes.

Date of Arrival____________________________________________________
Time of Arrival____________________________________________________
Date of Departure__________________________________________________

Check-in Time: 3 p.m. Check-out Time: 12 noon

Name ___________________________________________________________
Institution ________________________________________________________
Address _________________________________________________________
_____________________________________________________
Email ___________________________________________________________
Telephone No._____________________________________________________
Sharing Room with_________________________________________________

Special requests:___________________________________________________
_________________________________________________________________

Reservations requested after 18 September 2000 or after the room block has been filled are subject to availability and may not be available
MasterCard o Visa o

Credit Card# ______________________________________________________
Expir. Date__________________

o I authorize my account to be charged.

Signature___________________