Media Registration and Accommodation Form [International Conference on AIDS (11th: 1996: Vancouver, Canada)]

See back of form for accreditation criteria
Media credentials must accompany this form
_ 9 _1 ~U i I Ic'i MI h "

Please check the appropriate box:
Q Journalist
Q Photographer
Q Other
First Name I I I I

Reg. No: (
(For official use only)
Note: Every effort will be made by the Accommodation and Travel Bureau to place
you in your housing of choice. Hotel rooms will not be processed or assigned without
a completed Registration and Accommodation Form and the required hotel deposit.
Please remember hotel categories and rooms are assigned on a first come, first
served basis.

Q Camera Operator
Q Technician
I I I I t I I I I

Hotel check-in date and time
Last Name I I I I D I I I I I I I Date: L 1
mm dd
Hotel check-out date and time
Badge Information (Name as you would like it to appear on your name badge, te
Maximum 25 characters) Date:
mm dd

Approximate time: I I I
time am/pm
Approximate time: I I I I
time am/pm

Media
Organisation
Mailing Address
City/Town I

Room Type
SSingle Q Double
Q One bedroom suite:
Q Two bedroom suite:
SSmoking

Q Twin 0 Triple
Number of people
Number of people

Quad

Non-smoking

I have physical disabilities that require a special room
Specify Requirements:

Prov/State
CountryL

Postal/Zip Code

Room Sharing
Name(s) of person(s) with whom you are sharing a room

Telephone Cd
(Area Code)

Facsimile
E-Mail

(Area Code)

Registrant
Registrant

2)

*Non Registrant
*Non Registrant
*Non Registrant

Child Age:
Child Age:
Child Age:

I have attached my media credentials

Registrant

UNIGLOBE Advance Travel has negotiated special discounted airfares and car
rentals for the Conference and can assist you with your plans. Please check one
Q I will book my own travel
Q I would like a UNIGLOBE agent to contact me
If you want travel agent assistance please complete the following

*Each registrant must complete a separate Registration and Accommodation Form.
Hotel Preference
a) Indicate two category choices by letter (A, B, C, D or E). Prices are in
Canadian dollars (CAD) and indicate the price range per night in that category

Departure Date to Vancouver
Departure Date from Vancouver
Preferred airport for departure

mm dd yy
mm dd yy

Category A
Range: $200 $295
Deposit: $600
Category D
Range: $70 $99
Deposit: $200
First Category Choice

Category B
Range: $150 -$199
Deposit: $400
Category E
Range: $30- $69
Deposit: $100

Category C
Range: $100 - $149
Deposit: $300

Alternate Category Choice

Preferred airlineLI

Pali mop 0