midwest meeting

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MIDWESTERN AFCR MEETING
September 28-30, 1995
The Drake, Hotel
Chicago Illinois

Combined annual meeting of the Central Society for Clinical Research
Midwest Section, American Federation for Clinical Research
Midwest Society for Pediatric Research
Central Region, Society for Investigative Dermatology
Midwest Society for General Internal Medicine
and the Ambulatory Pediatric Association, Regions 5 and 6.

Preregistration Form

Name____________________________________________________

Address__________________________________________________

_________________________________________________________

City______________________ State____________ Zip____________

Telephone___________________________

Check one:
_____Enclosed is my check for $30.00 payable to appropriate society
(CSCR, MAFCR, MWSPR, or CSID). Please register me for the meeting.

_____I am a fellow, resident, student, or trainee. Please preregister me
for the meeting. I will bring a letter indicating my status to the registration
desk at the meeting or I will pay a $40.00 registration fee at that time.

Mail this form to:

CSCR
1228 W. Nelson
Chicago, IL 60657

On site registration will be $40.00

American Federation for Clinical Research-Midwest Section
September 28-30, 1995
Drake Hotel, Chicago, Illinois

Hotel Registration

Requests received after August 28, 1995 are confirmed subject ot
availability. For revisions or cancellations contact Hilton Reservation
Service. Obtain cancellation number.

Name__________________________________________________

Address_________________________________________________

City_______________________ State___________ Zip__________

Telephone______________________________

Arrival______________________ Departure____________________
Check-in time 3:00 PM Check-out time 12:00 Noon

Check in prior to 3:00 PM cannot be assured.
Reservations will be held until 6:00 PM unless accompanied by a first
night's deposit or an accepted credit card number and signature.

Please hold my reservation for:

____6:00 PM arrival.
____Guaranteed first nights deposit, check or money order.
____Guaranteed by my credit card - American Express,
Diners Club, Carte Blanche

Card #____________________ Expiration date ___________________

I hereby accept to pay for one night's accommodations should cancellation not be made
prior to 6:00 PM on day of arrival.

_______________________________
Signature

Please circle accommodation desired:

Single $155.00 Double $170.00

If the rate requested is not available, the closest available rate will be confirmed. No
charge for children sharing room with parents.
Additional Persons Sharing Rooms:
____________________________________________________

Mail this form to: Drake Hotel, Lake Shore Dr. and Upper Michigan Avenue, Chicago,
Illinois 60611

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