Document MG9gvMokQZ4bkN6E1JnDJDn1M

SHANGHAI HEALTH STUDY ANNUAL MEETING 17 - 19 AUGUST 2004 RESERVATION I REGISTRATION REQUEST Title: First Name: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Last Name: NameforBadge: ____________________________ Company or Affiliation: Address: Phone: ______________ Fax: Email: ACCOMMODATIONS: __ I I We plan to stay at Asilomar; please reserve a room.* I will arrive on: _________ Depart on: __I I We do not plan to stay at Asilomar and will make our own reservations. ADDITIONAL GUESTS: First and Last Name: (If you have children accompanying you, please supply their age) SPECIAL EVENTS: Yes I No __ I I We will attend the Welcome Reception and dinner (Tuesday evening, Aug. 17th) (# of adults __ # of children_ _) Yes I No_ _1 I We will attend the Cookout (Wednesday evening, Aug. 18th): (# of adults __ # of children_ _) I ( have I do not have ) special needs. Please let us know how we can assist. Please email to toddm@api.org or fax to Matthew Todd at 202-682-8031 no later than April 15th. * - Asilomar reservations are for August 17-19, 2004. Due to the Asilomar reservation policy, once you agree to reserve a room you will be responsible for payment even if you do not attend the meetings. Asilomar Conference Center + 831/372-8016 + Monterey Peninsula + CA SHELL-MCCLURG-056251