AFMC ASSOCIATION OF NORTH AMERICA
ELEVENTH ANNUAL MEDICAL CONVENTION AUGUST 5-8, 1999
NEW YORK MARRIOTT MARQUIS
1535 BROADWAY, NEW YORK NY 10035
Tel: 1-800-843-4898. Web address: http://marriotthotels.com/NYCMQ/
REGISTRATION FORM

NAME_________________________________ BATCH_____ FOOD (VEG/NON-VEG)_______
SPOUSE_______________________________ BATCH_____ FOOD (VEG/NON-VEG)_______
NAMES AND AGES OF CHILDREN ATTENDING
1. CHILD NAME______________________Age____ FOOD (VEG/NON-VEG)_______ M/F___
2. CHILD NAME______________________Age____ FOOD (VEG/NON-VEG)_______ M/F___
3. CHILD NAME______________________Age____ FOOD (VEG/NON-VEG)_______ M/F___
4. CHILD NAME______________________Age____ FOOD (VEG/NON-VEG)_______ M/F___
GUESTS NAME_____________________________FOOD(VEG/NON-VEG)_______
ANY OTHER GUESTS______________________________FOOD (VEG/NON-VEG)_______
ADDRESS____________________________________STATE_________ZIP_____________
TEL: (____)___________ FAX: (_____)____________E-MAIL:_____________@____________

MEMBERSHIP STATUS (Check One) LIFE MEMBER:$1000___ ANNUAL:$100___
RESIDENT:$25___ UNEMPLOYED:$5___.
IF NOT A MEMBER YET or YOUR DUES ARE NOT PAID,
PLEASE ENCLOSE MEMBERSHIP DUES WITH REGISTRATION FEES.
REGISTRATION FEES Until 4/15/99....After 4/15/99.....No...=..Ammount Enclosed
LIFE MEMBER .........................$275...............$300..x..___=..$_____________
REGULAR MEMBER................$325...............$350..x..___=..$_____________
SPOUSE.....................................$225...............$250..x..___=..$_____________
RESIDENTS..............................$225................$250..x..___=..$_____________
CHILD AGE 14 & UP................$225...............$250..x..___=..$_____________
CHILD AGE 13 & less...............$150...............$175..x..___=..$_____________
GUESTS....................................$225...............$250..x..___=..$_____________
MEMBERSHIP DUES(If not Paid)............................................$_____________
TOTAL ENCLOSED Check No:________for the ammount of :$_____________
TOTAL No. OF People Attending: ADULTS____CHILDREN 14 & over____13 and under____

Note: At MARRIOTT MARQUIS NEW YORK, NY 10036
We have booked 50 rooms at rate $160.00 + tax per day with cut off date of July 16, 1999.
CONTACT:
FREEDOM TRAVEL AND TOURS, INC. FOR ANY TRAVEL NEEDS OR OTHER
ARRANGEMENTS Tel: (310) 287-4799, Fax (310) 287-3100, Toll Free Tel: 1-877-303-3733

Mail Registration and Payment to (AFMC-AAA):
KISHORE K. AHUJA
748 BUCHANAN COURT
PARAMUS, NJ 07652 USA

Signature:_____________________Date:____/____/199__ (Mo/Day/1998)