Hotel Room Sharing Form

SIAM will keep a list of attendees who wish to share a room with another attendee to reduce expenses. If you are interested in finding a roommate and would like to be placed on the rooming list, please forward complete contact information to [email protected] (preferred) or fax it to the SIAM Conference Department at +1-215-386-7999. Be sure to mention that you want to be placed on the DS11 list. If information is incomplete, we cannot guarantee that your name will be included. SIAM will provide the listing electronically to all attendees on the list. It is the responsibility of the attendee to make the contacts and arrangements with other attendees on the list.

IMPORTANT: It is your responsibility to confirm details with your roommate and highly recommended roommates confirm with each other the day before arrival. In the event your roommate does not show up at the hotel, you will be responsible for the room charges in full.

Name of Conference:
Full Name:
Address:
Phone:
Fax:
E-Mail:
Arrival Date:
Departure Date:
Smoker:
Yes No
Gender:
Male Female

Please submit this information to SIAM.

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