2017 Room Share Form

For those 2017 AMIA Conference participants who are interested in sharing accommodation in New Orleans, AMIA will maintain a list of attendees searching for roommates. You will be emailed a copy of the list so that you may contact potential roommates directly.

We encourage you to reserve your room early.

Deadline is October 23, 2017

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* Contact Information

Name: *

Company:

City/Town: *

State: *

Country: *

Email Address: *

Phone Number: *

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* I prefer to be contacted by:

Phone

Either

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* I prefer....(please note: all rooms are non-smoking)

Double

Triple

Quadruple

No preferences

Other (please specify)

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* I arrive on (date)

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* I depart on (date)

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* Please list any special requests or requirements here - these will be included in the information sent to other room share participants.

Hotel Reservation Deadline Date: October 23, 2017

More information available at www.AMIAConference.com