Skin of Color Symposium 2017: Bench to Bedside
November 10-12, 2017
Lansdowne Resort and Spa, Leesburg, VA

Contact Info, Biosketch, Itinerary

Contact Info, Bio, Itinerary | Objectives, Presentation Requirements | Disclosure

Speaker Name: *
Email Address: *
Required entries with every submission*


Contact Information

Please list how you wish to be listed in the program


Mailing address:
Office Phone:
Mobile Phone: *
Home Phone:
Fax:
Assistant's Name:
Assistant's Phone:
Assistant's Email
Address:



BIO (used in the Syllabus and excerpts taken for verbal introduction)



CME
I am seeking CME credit for this meeting
I am NOT seeking CME credit for this meeting.


TRAVEL
I am driving to and from the meeting location
     Arrival Date/Time (approx) 
     Departure Date/Time (approx) 

I am FLYING to and from the meeting location

 I will arrange/have arranged for my own travel **RECOMMENDED**


ARRIVAL
I DO / I DO NOT wish to be shuttled from the airport to the hotel
Airport:      Airline:
Arrival date:      Flight Number      Arrival Time:

DEPARTURE
I DO / I DO NOT wish to be shuttled from the airport to the hotel
Airport:     Airline:
Departure date:      Flight Number:      Departure Time:


ACCOMMODATIONS
The SOCS is reserving a room for me.
OR
I understand I will be making my own room reservation. Click here for hotel information.

Please complete the following in either case:
I will be checking in on
I will be checking out on