ASA Meeting Participation Form

Meeting Participation Form
Questions
Purpose of trip*
Staff liaison*
How will you participate in this meeting?*

in personvia videoconference or teleconference
Travel date(s)*
Attendee's name*

First NameMiddle InitialLast Name
Attendee's address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Attendee's phone number (provide the best number for use over your travel dates)*

Area CodePhone Number
Attendee's email*
Emergency contact name*

First NameMiddle InitialLast Name
Emergency contact phone number *

Area CodePhone Number
Will you need air/train travel arrangements?*

yes, see Amex GBT instructions from staff liaisonno, I will arrange my own travel
If you require assistance please note the ASA is now booking through American Express Global Business Travel (GBT). Please see the GBT instructions sent from your ASA staff liaison.
All those traveling on behalf of the ASA should secure the lowest-priced, coach class, nonrefundable tickets for approved trips.
Will you need a hotel reservation?*

yesno
Hotel date(s) if different from event dates
Hotel preferences

Single OccupancyDouble OccupancySmokingNon-smokingLate check-inADA accessible
What are your meal preferences?*

beefchickenseafoodvegetarian
Do you have any food allergies?*

yesno
Please select*

dairygluten/wheatnutsseafoodother
Allergy details*
Should be Empty: