AHCDC - 2020 AGM

AHCDC Member or Trainee FREE

First Name

Last Name

Designation/Credentials

Facility/Hospital

Intended Date of Arrival (YYYY-MM-DD)

Intended Date of Departure (YYYY-MM-DD)

Do you need hotel accommodations on either May 28th, 29th, and/or 30th?

Yes No

- NEW THIS YEAR -

If yes, please book your own accommodations and fill out a reimbursement form which will be provided. The AHCDC will remunerate for up to three nights (Thursday, May 28, Friday, May 29, and/or Saturday, May 30). See the link “Book your Hotel Now” under Location & Hotel Bookings.

	Yes	No
Will you be attending the AHCDC Member Dinner Meeting on Friday night, May 29th?
Will you be attending the dinner on Saturday, May 30, 2020?

Please indicate any food allergies or specific dietary requirements

Do you have any special accessibility requirements?