Hotel Registration Form

CHEA Enhancing Usefulness Conference IV
The Madison Hotel • June 22-23, 2000

15th & M Streets, NW, Washington, DC 20005
Tel: (202) 862-1600 • Guest Fax: (202) 785-1255

To make your reservations, please mail this form directly to the hotel or call hotel reservations directly at (800) 424-8577 or fax your information to the hotel at (202) 785-4332. All reservations must reach The Madison Hotel prior to the May 30, 2000 cut-off date.

CHEA—Enhancing Usefulness Conference IV
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   Group Name

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   Name

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   Institution/Organization

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   Address

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   City                                                      State                                                      Zip

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   Tel                                                      Fax 

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   Number of Guests in Party                           Name(s)   

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   Arrival Date                                                   Departure Date

 All reservations must be guaranteed by credit card.

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   Credit Card #                       Expiration Date                   Credit Cardholder's Name

Lodging Rooms
Please indicate your choice of the following room types. Rate is subject to a 14.5% room tax. Additional persons are $20 each per night.

Single, $155.00                                Double, $155.00

Special
Requests:
Smoking
# ___ of Beds Requested
Non-smoking
Special Accessibility Needs