ASTRO 55TH ANNUAL MEETING Hope • Guide • Heal PATIENTS€¦ · ASTRO 55TH ANNUAL MEETING PATIENTS Hope • Guide • Heal Meeting Dates: September 22-25, 2013 † Exhibit Dates:

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First Name Last Name

Company/Organization

Street

City State Zip

Country Email

Phone (Please include country and city code for international phone numbers.) Fax

ALL HOUSING FORMS MUST BE RECEIVED BY AUGUST 29, 2013. We strongly encourage you to submit your housing form early for best hotel availability. Housing forms received after August 29, 2013, will be processed on a space-available basis and may be subject to higher rates. Please submit only one (1) form per person.

CANCELLATION AND CHANGE POLICYYou may cancel or make changes to your reservation in writing or online until 5:00 p.m. Eastern time on August 29, 2013. Written requests should be sent to the ASTRO Housing Center at [email protected] and will be acknowledged with an email confi rmation within fi ve (5) business days. To change or cancel a reservation online, you will need your confi rmation number and the email address that you used to make your reservation. Online requests are acknowledged with an immediate email confi rmation.

If you do not receive your confi rmation, please contact the ASTRO Housing Center to verify that your request has been received and accepted.

Starting September 2, 2013, if you need to change or cancel your reservation, you must call your hotel directly. Cancellations must be made at least 72 Hours prior to your scheduled arrival date or you will be assessed a cancel-lation fee equivalent to one night’s room and tax, which will be charged to your credit card.

This cancellation policy will be strictly enforced. Please retain the cancellation confi rmation from the ASTRO Housing Center or the cancellation number provided to you by the hotel, as this proof of cancellation will be required to resolve any credit card disputes.

How to Make a Reservation

HOTEL PREFERENCEPlease rank your top three hotel choices and select your room preferences. Please note that hotel rates may increase if there is more than one (1) person in a room. Reservation requests made directly with the hotel will not receive ASTRO’s discounted rates. Rates are exclusive of tax and service fees and may change without notice. Refer to the next page for the list of offi cial ASTRO hotels.

Hotel accommodations will be made on a fi rst-come, fi rst-served basis. If your preferences are sold out, ASTRO will secure a hotel reservation at a hotel with a room rate similar to those of your hotel preferences.

SPECIAL REQUESTS: Rollaway Bed (additional fees may apply) Handicapped Accessible Triple/Quad Room (additional fees may apply)

Specifi c Needs______________________________________________

Please note: Most Atlanta hotels comply with the ADA as required by law. ASTRO will not guarantee bed type or special requests. Please confi rm

your request with the hotel at check-in.

SELECT ONE (REQUIRED): Single (1 person/1 bed) Double (2 people/1 bed) Double/Double (2 people/2 beds)

SELECT ONE (REQUIRED): Smoking Nonsmoking

Check-in Date Check-out Date Sharing With

First Choice Second Choice Third Choice

Contact Information (REQUIRED)

ASTRO Member ID

PAYMENT METHOD

All hotel reservations require a credit card to guarantee your reservation. The credit card must have an expiration date no earlier than September 2013.

Check (U.S. dollars drawn on U.S. bank) Please make check payable to hotel and mail to ASTRO Housing Center.

Credit Card:

____Visa

____American Express

CREDIT CARD NUMBER

EXPIRATION DATE

CARDHOLDER’S NAME (as it appears on card)

SIGNATURE

BILLING ADDRESS – STREET

CITY STATE

COUNTRY ZIP CODE

Credit card for guarantee only.

PhoneDomestic: 1-800-541-6058International: 703-449-6418

Internetwww.astro.org/annualmeeting

MailASTRO Housing CenterJ. Spargo and Associates Inc.11208 Waples Mill Road, Suite 112Fairfax, VA 22030

Fax703-631-2971

QuestionsPlease contact Brittany Ramsey at 703-286-1568 or [email protected].

A S T R O 5 5 T H A N N UA L M E E T I N G

PATIENTS Hope • Guide • HealMeeting Dates: September 22-25, 2013 • Exhibit Dates: September 22-24, 2013 • Georgia World Congress Center • Atlanta

FACULTY HOUSING FORM DEADLINE: August 29, 2013

[email protected]

ATTENDEE HOTEL RESERVATION DISCLOSUREBy reserving a room at one of ASTRO’s offi cial hotels for the 2013 Annual Meeting, you understand that ASTRO and your assigned hotel(s) have exchanged your personal information for the purpose of facilitating your hotel reservation. You agree to release ASTRO, ASTRO’s offi cial hotels and their respective offi cers, directors, employees and agents from any liability relating to disclosure of your personal information for this purpose.

____MasterCard

____Discover

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