SIAM 45th Anniversary and Annual Meeting

DORMITORY RESERVATION FORM

Stanford University Governor's Corner Complex Information

Dormitory rooms are being held for our exclusive use until June 30, 1997.

To make a reservation, you must fill out and return this form to the SIAM office. Upon receipt of your reservation, a confirmation will be sent to you.

The cancellation deadline is June 5, 1997.

The Dormitory Package consists of:

SIAM Participant Information

Last Name:
First Name:
Gender: Male Female
Occupancy: Single Double
Date of Arrival:
Date of Departure:
Roommate Last Name:
Roommate First Name:
Roommate Gender: Male Female

Each participant must submit their own application. This information is needed for room assignments. If you are reserving a double room, you must supply the name of your roommate since SIAM will not randomly choose a roommate for you. Please be sure to fill out the entire form to ensure proper processing of your reservation.

Payment enclosed

Registration Deadline June 30, 1997

Cancellation Deadline June 5, 1997

Reservations will not be honored without accompanying payment in full!

Single Occupancy Package $422.75/person
Double Occupancy Package $354.00/person

Single Occupancy-additional nights 49.00 x # of nights = total single extra nights fee dollars.

Double Occupancy-additional nights 35.25 x # of nights = total double extra nights fee dollars.

Guest Housing Package*** $176.25 x # of guests = Total fee in dollars.

Total payment enclosed dollars.

Guest Information

A guest is a spouse, child, or significant other who is not attending the SIAM conference.

***Housing only, no meals are included, a rate of $176.25 for 5 nights is available for non SIAM participants who share a room with a SIAM participant.

Guest Last Name:
Guest First Name:
Gender: Male Female
Child: Yes No

Payment method

I choose to pay my dormitory room charges by:

Credit Card Number: Expiration Date:

Submitted by

Name:
Address:
City: State: Zip:
Telephone: E-mail:
Fax:
I am a disabled participant and require appropriate accommodations Yes No

Submit this form with payment to SIAM, 3600 University City Science Center, Philadelphia, PA 19104-2688, Fax number: (215) 386-7999.

This form must be received by SIAM on or before June 30, 1997.

Please note:

A key deposit of $70 will be required upon checking in. It can be payable either with a credit card or personal check (U.S. funds on a U.S. bank). This deposit of $70 will be returned upon receipt of the key(s) at check-out. No smoking is allowed within the residences or within 20 feet of any residence.
Check-in-time 3:00 PM. Check-out time 12:00 noon.


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MMD, 4/17/97