* INVITATION & 3rd CALL FOR PAPERS *
REGISTRATION Form
22nd Annual Congress – Caribbean Society of Radiologists
July 23rd – 26th, 2015
Sheraton, Lake Buena Vista, ORLANDO
Please complete & return to Secretary: Fax (784) 457-2307
*E-mail: rosalind.ambrose1@gmail.com
Name of Participant
…………………………………………………………
(Please PRINT in Capitals)
Name of Spouse/Accompanying Person…………………………………………….
(Please PRINT in Capitals)
Mailing Address……………………………………….………………….…….……
(Please PRINT in Capitals)
Mailing Addr. Cont’d:………………………………………………………. ……….
(Please PRINT in Capitals)
Phone (H)……………………………Ph(W)…………………………..…………...
Fax:………………………………….E-mail:………………………….…..……….
HOTEL ACCOMMODATION: [ ] Yes
[ ] No
Single, Double, Triple/Quad Occup: $89.00US +12.5% Service Charge & Govt. Tax)+$19.95=
Mandatory Resort Fee, No Meal Plans
To BOOK- Please submit Registr.Form to Secretariat & Contact Hotel Directly: Delegates MUST provide CREDIT CARD info. to HOTEL IN ADVANCE to ENSURE
BOOKING –by July 2, 2015. Final Rooming List MUST be presented by this date.
Hotel Booking Link: https://www.starwoodmeeting.com/Book/caribrad : Confirmation
# as from March 14th is 745208 / or Call +1-407-239-0444 and press option number 1.
** CONCESSIONARY ROOM RATES from July 22 – 30, 2015**
Presenting a Paper : [N] / [Y] Topic : ……………………………………………………
Kindly Submit Brief Biography and Abstract – by July 6th, 2015
4 CME/CSR Credits are awarded for this Congress
Suggested Item for Business Session…………………………………..……………….
Registration & Membership Fee: $160US Financial Member $220US New Member
$ 60US Accompanying person
RT-Techs & Non-Radiologist: $ 100US
Fees are payable to: CARIBBEAN SOCIETY OF RADIOLOGISTS due Congress Day 1.
Signature………………………………………… Date…………………………….…
CARIBBEAN SOCIETY OF RADIOLOGISTS – Tel: 784-457-0317 / Fax: 784-457-2307 / e-mail:Rosalind.ambrose@gmail.com