Roommate Matching Service

In an effort to reduce the cost of the 2004 EMS meeting, EMS is again providing a roommate matching service. If you are interested in sharing room costs, please submit this completed form.

Matched roommates will be contacted and they will then have to make the appropriate reservation at the hotel's Web site. Special EMS rates can not be guaranteed after August 27, 2004.

Please note that this is only a matching service. Matched roommates will still be responsible for making their own hotel reservations!

Fields in Red are required.

Last Name	First Name	Middle Name
Address
City	State/Province	Zip/Postal Code
Daytime Phone Number	Fax	e-mail
	Male Female
Age	Gender
Yes No	Yes No
Smoker	Share with a Smoker?
01-October-2004 02-October-2004 03-October-2004 04-October-2004 05-October-2004	03-October-2004 04-October-2004 05-October-2004 06-October-2004 07-October-2004	1 2 3 4 5 6
Arrival Date	Departure Date	Number of Nights a room is needed?
If you already have a preferred roommate, please provide name and contact information:
Last Name	First Name	Middle Name
Address
City	State/Province	Zip/Postal Code
Daytime Phone Number	Fax	e-mail

   

Complete this form and submit it. Please note that information marked in red* above is required before the computer will accept your submission. Refer any questions about the EMS Roommate - Matching Service to: paul_white@hc-sc.gc.ca. Refer any technical questions about this form to The EMS Webmaster.

EMS Contact Information:
1821 Michael Faraday Drive, Suite 300, Reston, VA 20190
Phone: (703)438-8220    FAX: (703)438-3113
EMS E-Mail:

Last Modified: August 21, 2006