Proteus Syndrome Foundation Family Conference
September 18 - 19
DoubleTree by Hilton
8120 Wisconsin Avenue
Bethesda, MD 20814
(301) 652-2000
Presented by
The Proteus Syndrome Foundation
www.proteus-syndrome.org
DETAILS:
You can register by mail and pay by check or money order.
Mail: Fill out the attached form and mail the registration section and your payment to:
Proteus Syndrome Foundation
c/o Kim Hoag
4915 Dry Stone Dr.
Colorado Springs, CO 80923 USA
OR
To pay by credit card go to www.proteus-syndrome.org and follow the conference links.
Please have registration forms to us by Monday, August 24, 2015.
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If you cannot get your form back by August 24, please contact Kim Hoag to let her know you will be attending.
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Phone: 719-660-1346
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Email: kim@cheersliquormart.com
You will pick up your conference packet when you check into the conference
on Thursday night or Friday morning depending on when you arrive.
LODGING:
YOU MUST RESERVE YOUR ROOM NO LATER THAN MONDAY AUGUST 24, 2015 TO RECEIVE THE DISCOUNTED ROOM RATE. Please follow this link to register for your room at the reduced rate of $119.00 per night + taxes
The web page address is: http://doubletree.hilton.com/en/dt/groups/personalized/W/WASBHDT-PS9-20150916/index.jhtml?WT.mc_id=POG
Group Name:
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PROTEUS SYNDROME FOUNDATION
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Group Code:
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PS9
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Check-in:
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16-SEP-2015
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Check-out:
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20-SEP-2015
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Hotel Name:
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DoubleTree by Hilton Hotel Bethesda - Washington DC
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Hotel Address:
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8120 Wisconsin Ave. Bethesda, Maryland 20814-3624
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Phone Number:
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301-664-7343
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Hotel Guest Room Rates: Single/Double Rates are $119.00 plus state & local taxes (currently 13%).
The DoubleTree by Hilton has a full-service restaurant, swimming pool, fitness center & laundry facilities. Check in is 3:00pm and a 12:00 noon checkout.
CHILD CARE AND ACTIVITIES:
All-day childcare with age appropriate activities will be offered for children during the Friday/Saturday conference. Please bring any ‘special toys’ or blankets etc., which your children may find comforting.
CONFERENCE FEES:
The cost of the conference which includes registration, meals and conference materials is:
Must be paid in US dollars.
$95.00 per individual
$30.00 per child 12 and under - includes child care and meals same as individuals.
CONFERENCE SCHEDULE:
Thursday, Sept 17 6 - 8 PM Registration; Family Meet-And-Greet, Hamburgers,
Hot Dogs & Trimmings (included in conference fees)
Friday, Sept. 18 7 - 8 AM Breakfast on your own; Registration
8 AM - 5 PM All-day Meeting/Speakers/Break Out Sessions
Morning Snack & Lunch Included
Dinner on your own
Saturday, Sept. 19 9 AM - 5 PM Breakfast on your own. All-day Meeting/Speakers/Break Out Session/Morning Snacks & Lunch Included
6 - 9 PM Dinner in hotel (Included in conference fees)
Depart on Sunday, September 20, breakfast on your own.
There will be breakout group sessions with the presenters/doctors during the conference on Friday/Saturday.
You will be able to register for the sessions you wish to attend when you arrive at the conference.
Teleconferencing: We are working on the possibility of offering teleconferencing to those who are unable to attend. Details to follow.
Return Registration form by August 24, 2015.
Please contact Kim Hoag if you have questions:
kim@cheersliquormart.com or 719-660-1346
REGISTRATION FORM
Please fill out both pages of this registration form
and return it by Monday, August 24 to:
Email: kim@cheersliquormart.com
or
Proteus Syndrome Foundation
c/o Kim Hoag
4915 Dry Stone Dr., Colorado Springs, CO 80923 USA
Name: ________________________________________
Address: _______________________________________________________________________________________
_______________________________________________________________________________________________
Phone: _________________________________ Email: ______________________________
Name of Child or Adult family member with Proteus syndrome_________________________________________
I give permission to print our name, address and phone # in the packet of conference materials Yes __ No___
Do you request financial assistance Yes ______ No _______ (if yes you will be contacted by the foundation)
Registration Fees: (Registration fees include, Friday lunch, Saturday breakfast, lunch & snacks during conference, dinner reception, daycare and conference materials).
Pre-registration for meeting helps us estimate room size and catering needs.
Payment must be made in US dollars.
Make checks or money orders payable to The Proteus Syndrome Foundation
$95.00 per individual $____________
$30.00 per child 12 and under $____________
Scholarship Fund Donation: Your contribution to this fund helps offset
registration fees for other participants and is greatly appreciated. $____________thank you
Total Amount Enclosed $____________
Please RSVP on ALL items below.
The Friday & Saturday conference includes lunch and one snack break.
If you will not be having lunch at the conference please note that below.
List the names of those who will be attending the conference. Please list ages of all children. Please write Y (yes) or N (no) if each person is attending Thursday, Friday & Saturday.
Name Age Day’s Attending Conference
Thursday dinner Friday Saturday
______________________ ___ _____ ______ ______
______________________ ___ _____ ______ ______
______________________ ___ _____ ______ ______
______________________ ____ _____ ______ ______
______________________ ____ _____ ______ ______
______________________ ____ _____ ______ ______
SATURDAY EVENING PSF DINNER
The Proteus Syndrome Foundation invites you to attend dinner Saturday evening
6:00pm – 9:00pm.
Once we receive your registration form you will be contacted for your evening food choices. |