2019 Room Share Form

AMIA Room Share Program

For those 2019 AMIA Conference participants who are interested in sharing accommodation in Baltimore, AMIA will maintain a list of attendees searching for roommates. You will be emailed a copy of the list so that you may contact potential roommates directly.

We encourage you to reserve your room early.

Deadline is October 7th, 2019

Question Title

* 1. Contact Information

Name: *

Company:

City/Town: *

State: *

Country: *

Email Address: *

Phone Number: *

Question Title

* 2. I prefer to be contacted by:

Phone

Either

Question Title

* 3. I prefer....(please note: all rooms are non-smoking)

Double

Triple

Quadruple

No preferences

Other (please specify)

Question Title

* 4. I arrive on (date)

Question Title

* 5. I depart on (date)

Question Title

* 6. Please list any special requests or requirements here - these will be included in the information sent to other room share participants.

Hotel Reservation Deadline Date: October 9th, 2019

More information available at www.AMIAConference.com