1998 Eleventh Annual Pediatric Critical Care Colloquium

Hotel Registration Request

Eleventh Annual Pediatric Critical Care Colloquium

"Looking to the New Millennium"

September 16-20, 1998

Return registration to:
The Renaissance Chicago Hotel
1 W. Wacker Drive
Chicago, IL 60601
(312) 372-7200
fax (312) 795-3474

It is recommended that you make your reservations by phone directly with the hotel. However, if you prefer to mail your reservation, please complete this form and mail it to the hotel. If you prefer to fax your reservation request to the hotel of your choice, be sure to include your credit card information to guarantee your room. It is your responsibility to confirm that your reservation was received by the hotel.

Please reserve_________ Room(s) for__________ Person(s)

__________________________________________________________________________
NAME

__________________________________________________________________________
NAME OF SECOND OCCUPANT

__________________________________________________________________________
ADDRESS

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CITY/STATE/ZIP

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PHONE NUMBER

Room Preference Smoking ____ Non-Smoking ____	Arrival: Day_________Date_________Time_________
Single ___ ($189.00/night) Double ___ ($189.00/night) (Club room and suite rates available upon request)	Departure: Day_________Date_________Time_________

NOTE: Check-in time is 3:00 p.m. Check-out time is noon.
***Pediatric Intensive Care Fellows (with a letter from their Fellowship Director) will receive a $50.00/day/room up to a total of $100.00 credit at the Renaissance.***

Reservations are accepted on a first-come, first-serve basis until August 18, 1998. All reservations received after this date will be accepted on a space-available basis only.

First night's deposit (or credit card guarantee) required

Payment type:
____Check ___American Express ____Visa ____Mastercard

Credit Card#________________________________________________

Expiration Date__________ Signature__________________________