Advanced registration is strongly recommended. Register by July 1, 2008, to receive the early bird rate. For advanced registration, a confirmation will be sent to the address or email listed on this form. Please print/type all information.
First Name: __________ Last Name: _________ Chinese Name:__________
Mailing Address: __________________________________________
City: _________________ State: ______ ZIP/Postal code: _____________
Phone: ____________ Fax : ____________ E-mail: _______________
Department: Medicine___ Dental___ Pharmacy___ Nursing___ Medical Technology___
Year of graduation ______ Vegetarian: yes___no___
Family member(s) attending the convention:
Spouse's Name: English __________Chinese ______Vegetarian: yes___no__
If NTUMC alumni: Dept of ________Year of graduation:______
Other family members:
Name: English _______________Chinese __________ Vegetarian: yes___no__
Name: English _______________Chinese __________ Vegetarian: yes___no__
| Description | Unit Charge | # of Persons | Sub-total |
|---|---|---|---|
| MEMBER (This includes meeting registration, 2 breakfasts, 1 lunch and the dinner banquet) | |||
| Early Bird | $ 235 | x_____ | $__________ |
| After July 1, 2008 | $ 265 | x_____ | $__________ |
| SPOUSE/GUEST | |||
| Lunch 8/9/08 | $ 30 | x_____ | $__________ |
| Dinner Banquet 8/9/08 | $ 80 | x_____ | $__________ |
| POST-CONVENTION TOURS | |||
| #1 Niagara Tour | $ 460/person, double occupancy | x_____ | $__________ |
| $ 681/person, single occupancy | x_____ | $__________ | |
| #2a Cleveland City Tour | $ 20/person | x_____ | $__________ |
| #2b Cleveland Pop Orchestra | $ 55/person | x_____ | $__________ |
| #2a + #2b | $ 75/person | x_____ | $__________ |
| GOLF TOURNAMENT | $ 100/person | x_____ | $__________ |
| TOTAL (Make check payable to NTUMCAA-NA) | $_________ | ||
| DONATION (Make separate check payable to NTUMC Alumni Foundation. ) | $_________ | ||
Mail: Mail the checks and registration form to Dr. Sutek Lie, 989 Hillcreek Lane, Gates Mills, OH 44040
Refund/Cancellation Policy: Cancellation request should be in writing and postmarked by July 15, 2008 to avoid a 10% charge.
Hotel Accommodation:Participants are encouraged to make hotel reservation as early as possible by calling 216-696-5600 or 1-800-264-0165 to Renaissance Cleveland Hotel mentioning the special code: NTUNTUA for the group rate of $149 plus taxes per night. You can also book online at Renaissancecleveland.com using the same code.
Questions: Wuu-Shung Chuang, M.D., 395 Edgemeer Place, Oberlin, OH 44074
Tel: 440 775-1675; E-mail: wschuang@aol.com