| Chicago Hilton and Towers |
| 720 S. Michigan Ave., Chicago |
| Tuesday, August 8, 2000 |
| 12:30 p.m. – 3:00 p.m. |
| |
| Briefing Registration Form |
| NAME: ___________________________________________________ |
| TITLE/AFFILIATION: ______________________________________ |
| PUBLICATION/MEDIA: ______________________________________ |
| ADDRESS: ________________________________________________ |
| CITY: _____________________ STATE: _______ ZIP: ___________ |
| PHONE: ______________________ FAX: ________________________ |
| E-MAIL: ______________________________ |
| |
____ Yes, I plan to attend. (Only credentialed media will be admitted. Identification will be required.) |
| |
Please return this form by mail or fax to: |
| Jim Michalski |
| American Medical Association |
| 515 N. State Street, 15th Floor |
| Chicago, IL 60610 |
| Phone: 312/464-5785 |
| Fax: 312/464-5839 |
| E-mail: Jim_Michalski@ama-assn.org |
