Executive Committee & Business Board of Advisors Meeting 2008

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2008 NHCSL Health Disparities Conference
September 11-13, 2008 – Wilmington, DE
Hilton Wilmington/Christiana - 100 Continental Drive, Newark, DE 19713

NHCSL Airline and Hotel Request Form

Personal Information

First name: *
Last name: *
Vegetarian: *	Yes, I require vegetarian meals. No, thank you.
Guest name: *
	Name of person accompanying you Note: Travel agency can make reservations for your guest, but you must provide them with credit card info. You are responsible for payment of their ticket

Flight Information

YOUR TICKET WILL BE AN E-TICKET

Seats:	Number of attendees requiring this flight
Departure Date:	Sep 11, 2008
	The official program begins at 8 AM on September 12
Time of Departure:	Aproximate desired time of departure
Departure Airport:
Seating preference:
Airline Carrier #1:	First choice preferred airline carrier
Frequent Flyer #:
Airline Carrier #2:	Second choice preferred airline carrier
Frequent Flyer #:
Return Date:	Sep 13, 2008
	The official program concludes following lunch on September 13, The conference will only cover your stay through your departure on Saturday, September 13
Time of Departure:	Aproximate desired time of departure
Return Destination:	City or Airport

Hotel Information

Name:	Hilton Wilmington/Christiana
Address:	100 Continental Drive, Newark, DE 19713
Bed type: *	King Double
Smoking room: *	Yes, please. No, thank you.

Contact Information

A copy of the itinerary and reservation confirmation number will be sent to this address as well as electronically

Address: *
City: *
State: *
Zip Code: *
Telephone: *	10 digits
Fax: *	10 digits
Email: *
	A copy of the itinerary and reservation confirmation number will be sent to this address

NOTE: All reservations will be confirmed with you. If you cancel or do not show once your reservations have been made and confirmed, you will personally be responsible for all fees incurred as a result of this cancellation. If you wish to fax the completed form please send it to Tatiana Guerra at fax # 202/434-8072