Delegate Registration



First Name: Last Name:
Degrees: M.D. D.O. D.P.M. D.D.S. D.M.D. Other Other degree(s):
Hospital:
Department: PGY:
Home Street Address:
City: State: ZIP Code:


Mobile Phone:

Email:


ROOM RESERVATION CIR will pay the full cost of the room ($225 plus $32.60 tax per night double occupancy) at the Omni Shoreham Hotel, if you share the room with another delegate.
Roommate preference:	I want my own room, and understand that I will pay $128.80 per night. Please choose a roommate for me -- I am afemale male I will share a double room with Dr. -- I have his/her approval.
(You must provide a current credit card when you arrive at the hotel. Any incidental expenses you incur during the convention (phone calls, room service) will be charged to your credit card. If you cancel 72 hours before your scheduled arrival date, you will not be responsible for any charges.)
Dietary restrictions:	None I do not eat meat I do not eat meat or fish Other If other, please specify:
TRAVEL, ARRIVAL AND DEPARTURE INFORMATION Please make your plane or train reservations with UN Travel: Call (800) 234-8685 and indicate that you are attending the CIR convention. PLEASE NOTE that the CIR 2008 National Convention begins on Friday, May 16 at 6:30 pm with registration and reception at the Omni Shoreham Hotel. I will arrive in Washington, D.C., on:
	Friday, May 16th at ampm
	or Saturday, May 17th at ampm (The Convention begins at 8:30 am sharp!)
I will travel by:	plane train car other
I will leave Washington, D.C., on:
	Saturday, May 17th at ampm
	or Sunday, May 18th at ampm

ROOM RESERVATION

TRAVEL, ARRIVAL AND DEPARTURE INFORMATION