The Journal of the Arkansas Medical Society Med Journal April 2019 Final 2 | Page 10

OTEL RESERVATIONS
r room reservations,
call the DoubleTree Hotel at 501-372-4371 and mention the Arkansas
Member Name: please
___________________________________________________________________________________________
edical Society
rate of $139 per night rate for a single or double room. Reservations must be made by
Spouse or Guest Name: ____________________________________________________________________________________
arch 30, 2019 in order to receive the rate.
Address: ________________________________________________________________________________________________
City: _______________________________________________________________ State: ______ Zip: _____________________
Phone: ____________________________________________ Fax: __________________________________________________
Email:___________________________________________________________________________________________________
Section 2: Registration
AMS Physician Members or their Staff:
Registration Fee
$135 Per Person
Physician Non-Members or their Staff:
Registration Fee
$235 Per Person
AMS Night at the Travs (Thursday, April 25):
$12 Per Person
Please help us make an accurate meal order by indicating the
number of people, including yourself, who will attend the
following:
Spouse or Guest:
Registration Fee
$ 65 Per Person
Medical Student and Resident Members or their Guests:
Registration Fee
____________ AMS Night at the Travs (Thursday)
____________ Inaugural Gala (Friday)
$ 25 Per Person
Section 3: Payment
Payment Method: □ Check
□ VISA
□ Mastercard
□ Discover
Name on credit card: ______________________________________________________________________________________
Signature: _______________________________________________________________________________________________
Billing Address: ___________________________________________________________________________________________
City/State/Zip: ____________________________________________________________________________________________
Total Amount to be charged to card: $ _________ Email for Receipt: _________________________________________________
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Credit Card Number
__ __ /__ __ __ __ __
Expiration Date 3-Digit Code
Special Assistance Available: If you are a person with a disability or have special dietary needs, please let the Society office know in
advance so we can arrange to make your attendance as convenient and comfortable as possible.
Please make checks payable to AMS. Registration forms may be mailed to: AMS, PO Box 55088, Little Rock, AR 72215.
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