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We request that you complete the information below, as it will assist our conference coordinator in preparing the initial conference quotation. A final detailed quotation will be provided once personal contact has been made with you to determine your exact requirements.
Please enter your contact information * = mandatory field
First Name *
Last Name *
Title *	Mr Mrs Miss Ms Dr
Company/Organisation Name*
Position
Street Address*
City*
State*
Postcode*
Country*
Contact Phone Number*
Fax Number *
Contact Email*
Are you a Choice Privileges member?	No Yes
Contact Preference	Email Mail Fax
Daily conference/meeting program schedule
Arrival date	01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 01 02 03 04 05 06 07 08 09 10 11 12 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Departure date	01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 01 02 03 04 05 06 07 08 09 10 11 12 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Daily Start Time	00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59
Finish Time	00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59
Meeting Room Requirements
Number of delegates attending the conference
Number of meeting rooms needed
Other Details awards night/gala dinner, team building activities, recreational
Additional delegates/partners not attending conference session.
Meeting room layout	Theatre U shape Classroom Boardroom Banquet Cocktail
Specify room layout requirements i.e. Day 1 Boardroom, Day 2 Banquet
Additional Services
If you require food & beverage, audio-visual equipment or any other services, please enter your requests below to assist our conference coordinator in preparing an initial quotation for you.
Audio Visual Equipment Required
Catering (indicate number of persons in box) No’s   No’s Breakfast Afternoon tea Tea/Coffee with registration Lunch Morning tea Dinner
Identify any special catering requirements
For other requirements please detail below (eg sporting/leisure activities such as golf, tennis)
Other Comments e.g. Social delegate requirements, partners attending
Please indicate whether you would like more information on any of these options during your conference	Facilitators Entertainers Golf Winery Tours Other
Your Accommodation Requirements
Will you require accommodation for conference delegates?	Yes No
Number of hotel rooms
Room types required:	Single Double
	Other please specify
Budget An indication of your conference budget for meeting rooms, accommodation, food and beverage and entertainment	$
Yes I would like to receive regular email updates of Choice Hotels Conference & Meetings news.