2010 Room Share Form

For those 2010 AMIA Conference participants who are interested in sharing accommodation in Philadelphia, AMIA will maintain a list of attendees searching for roommates. You will be emailed, faxed, or mailed a copy of the list so that you may contact potential roommates directly. Please try to submit your information as early as possible while appropriate room accommodations are still available.

Deadline is October 8, 2010

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* Contact Information

Name: *

Company:

City/Town: *

State: *

Country: *

Email Address: *

Phone Number: *

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* Gender

Female

Male

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* I prefer

Double

Triple

No preferences

Other (please specify)

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* I arrive in Philadelphia on (date)

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* I depart Philadelphia on (date)

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* Please list any special requirements here

Hotel Reservation Deadline: October 1, 2010

The conference hotel is the Loews Philadelphia Hotel. Please note that the AMIA conference rates are $159 USD per night plus tax.

Deadline is October 10, 2010. More information available at www.AMIAConference.com