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

Full name of contact person and media organisation

(Name)
V V[0 e ~I [ O0] 1 I: "\ \to:
Billeting / A Billeting program is in the process of being established.
Are you interested in being billeted? Q Yes Q No
f you check yes, further information will be forwarded to you. However, all interested
delegates are asked to complete accommodation information and submit a hotel
deposit as on alternative to billeting.
Submit accommodation deposit for your first category choice for each room
requested. We accept Canadian dollars only, by credit card or bank draft.
Cheques cannot be accepted.
Accommodation Deposit (Submit fee for your first category choice)
Category A $600 CAD Category D $200 CAD
Category B $400 CAD Category E $100 CAD
Category C $300 CAD
Enter total deposit in Canadian Dollars (CAD) only CAD I$
ETI I O[ Dx]A I,Yi!1 i

(Medica organisation);1 _ "l \ 1 "o \ Iu l / []

GENERAL PAYMENT INFORMATION

I. Submit fees by bank draft or credit card only.
2. Bank drafts are payable only in Canadian dollars and must be
drawn on a Canadian bank. Make bank drafts payable to:
XI International Conference on AIDS Society on behalf of the IAS.
3. Accepted Credit Cards are:Visa/Mastercard/American Express.
ACCOMMODATION INFORMATION
I. Hotel Confirmation -The Accommodation and Travel Bureau will
confirm your hotel assignment in writing.The assigned Hotel will also
issue a confirmation under separate cover.
2. Assignment Policies Rooms will be assigned in order of receipt
of request.Telephone reservations will not be accepted.
3. A maximum of one room will be assigned per registered media
person.
4. Change in Accommodations - Changes or cancellations must also
be submitted in writing and forwarded to the Accommodation and
Travel Bureau.
5.The processing and refunding of monies will be in accordance with
the Conference Cancellation Policies and deadlines stated below.
ACCOMMODATION CANCELLATION REFUNDS

Bank Draft (Payable to: XI International Conference on AIDS

on behalf of the IAS)
Q American Express

Credit Card Q Visa

Mastercard

Name as it appears on the card of card holder responsible for charges:

Credit Card Number
Expiry Date I

Over 30 days prior to arrival date:
Full refund of occommodation deposit
0 - 30 days prior to arrival date:
No refund
For inquiries regarding hotels, please contact the
Accommodation and Travel Bureau:

Authorisation SignatureI
I have read, understood, and agreed to the conditions of registration, accommodation and
deposits as outlined in this form.

Signature

Date Signed

I L Canada/US Phone: I 800 555 I 099
mm dd yy
Worldwide Phone: 604 66 I 4962
Fax: [phone]

U e.] " 1LI"U 1~@i

REGISTRATION
Date Rec'd II
mm
Processed by I I
Documents attached

J I Compl./Proc. Date
dd yy
Li Verified by I

mm dd yyI I
mm dd yy

Yes H No

Approved ] Yes H No

ACCOMMODATION
Date Rec'd 1! 1I! I
mm dd yy

Compl./Proc. Date

mm dd yy

Processed by I I 1 I I I Verified by I I I I

L I I I

Assigned Housing Bureau Conf No l

Payment ] VISA H MC H Amex Q BD [ NP $