Name__________________________________________________________________________________
Address________________________________________________________________________________
City/State/Zip___________________________________________________________________________
Arrival Date________________________________ Departure Date________________________________
Number of rooms______________ Number in Party: Adults________________ Children_______________
Room Type: 1 King Size Bed___________________ and/or 2 Double Beds_________________
 Separate check made payable to the Hyatt enclosed with program registration.
Please guarantee my Hyatt reservation by billing to the credit card below:
( check one) American Express Master Card VISA Diner's Club Discover
Account Number__________________________________________ Exp. Date_______________________
Name on Card (Please Print)________________________________________________________________
Credit Card Billing Address (if different from mailing - for verification purpose)
______________________________________________________________________________________
Cardholder's Signature____________________________________________________________________
Due to the popularity of Sarasota as a vacation destination, it is advisable to make your hotel reservatons as early as possible. Room reservations less than 30 days prior to the program are based upon availability. Rates are subject to state and local taxes.
Send Program Registration and/or Separate Hyatt Check To:
American Medical Seminars, Inc.
P.O. Box 49947
Sarasota, FL 34230-6947
Or For Further Information, You May Contact Our Office at:
Toll Free: 866-ams-4cme (866-267-4263)
Direct Line: (941) 388-1766
Fax: (941) 365-7073
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