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Date *

/ /

First Name: *

Last Name: *

Business/Organization Name:

Title:

Address: Street:

City:

State/Province:

Zip code

Email: *

I want to attend the following event(s).

Symposium at Harvard Medical School Longwood Campus on Thursday, August 23, 2018: 7:30 am to 5:00 pm *

Yes
No

Number of attendants including you

Do you need hotel room?

Yes
No

If Yes, Number of room(s):

Number of bed in each room(4 persons in 2 beds room):

1 bed
2 beds

Check-in Date

/ /

Check-out Date:

/ /

After returning from NH: Check-in Date

/ /

After returning from NH: Check-out Date

***Hotel: Boston Marriott Copley Place, 110 Huntington Ave, Boston, MA 02116, Phone: (617) 236-5800 Rate: $179.00/per room/night plus 14.45% tax;You will pay the hotel at check in based on your given confirmation code

Welcome Dinner: Boston Clambake at KTBF, Burlington on Thursday, August 23, 2018: 6:30 pm to 9:00 pm *

Yes
No

Trail of Thai Royalty in Massachusetts Tour in Boston, Brookline, Cambridge, and Mourning the Late King's Passing at The King Birthplace monument, Cambridge on Friday, August 24, 2018: 4 pm to 8 pm *

Yes
No

Trail of Thai Royalty Dedication at Mt. Washington in New Hampshire and Tour on Saturday, August 25, 2018 *

Yes
No

New Hampshire and Tour : Do you need hotel room? *

Yes
No

If Yes, Number of room(s) plus 9% tax; breakfast is included

single - $105
double - $132
Triple - $155

***Hotel in NH: Town & Country Inn and Resort, Shelburne, New Hampshire, Phone: 603-466-3315 Dinner menu choice (select one):

Roast Prime Ribs of Beef, au jus
Poached Atlantic Salmon
Filet of Boston Haddock
Baked Boneless Stuffed Chicken Breast

Number of attendants including you

Will you be on the bus with the group in Boston? *

Yes
No

Will you be on the bus with the group in NH? *

Yes
No

Will you be up the summit ? *

Yes
No

If yes, will you go with us or drive?

go with the group
drive

Do you need any special assistance? *

Yes
No

If Yes, please specify:

Question: Contact 781-365-0083 or email: ktbf@thailink.com

Name of additional attendees: (Name & Email Address) Additional attendees

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