Registration forms

Virginia Neurological Society
2016 Meeting Registration forms:

 

To register for the annual meeting, complete the information below and send this document to me as an email attachment to: sona.pomfret@vaneurosoc.org 

 

OR

The information below may be completed and sent by fax to: 804 784-8818.

 

Name:       

Mailing Address:       

City, State:       

Zip Code:       

Phone Number:       

*Email Address:       

 

*If you are sending this completed form by fax, please include your email address to receive confirmation that your registration form was received.

 

 

Reservation Request

 

 

Virginia Neurological Society

 

January 26-28, 2017


PLEASE NOTE THAT THE BELOW RATES APPLIED TO THE 2016 MEETING.

PLEASE CONFIRM RATES AT TIME OF BOOKING.

 

_______________________________________________________________________

 

 

 

The following daily rates are per room, per day based on the Modified American Plan (breakfast and dinner)

 

$223.00 Single and $313.00 Double Occupancy

 

Rates listed below are for upgrades to guarantee specific room types and suites (based on availability)

 

 

 

Please circle preferred rate:

 

 

 

ROOMS:                                                                                             SUITES:       (Based on availability)              

 

Deluxe                                   Single - $233.00   Double - $323.00                                Executive Studio Suite:     Single -$273.00 Double - $363.00

 

Deluxe View                         Single - $243.00   Double - $333.00                                Homestead Executive Suite: Single -$298.00 Double - $388.00

 

Premier                                  Single - $253.00   Double - $343.00                                Luxury Landmark Suite: Available Upon Request

 

Premier View                        Single - $263.00   Double - $353.00                                 Luxury Presidents Suite:   Available Upon Request

 

 

 

Children sharing room with parents:

 

0 to 5 years –Complimentary           6-12 years old - $32.00     13-17 years old -  $90.00                   Additional Adult - $115.00

 

 

 

10% daily resort charge is additional.  Package prices are subject to applicable state and local taxes (currently 9.3%) in effect at the time of check-in.

 

______________________________________________________________________________________________________________________________

 

 

 

 

 

Arrival date:___________________________/Time:____________ Departure date:______________________________/Time:____________

 

 

 

Name (please print) ________________________________________________________________________________No. of adults  ______

 

 

 

Room mate (if applicable)  ____________________________________________________________________________________________

 

 

 

Address ___________________________________________________________________________________________________________

 

 

 

City_______________________________________________________ State__________________________ Zip Code_________________

 

 

Daytime Telephone  _____________________________________ ____FAX

 

 

 

©2005 Virginia Neurological Society - All rights reserved.
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