Congress of Clinical Dermatology
May 24 - 27, 2019
Hilton Sandestin

Contact Info, Bio, Itinerary

Contact Info, Bio, Itinerary | Educational Objectives | AV, Final Presentation, Handouts | Disclosure

Speaker Name: *
Email Address: *
Required entries with every submission*

Contact Information

Please list how you wish to be listed in the program (Name and Credentials)
Mailing address:
Office Phone:
Mobile Phone:
Home Phone:
Fax:
Assistant's Name:
Assistant's Phone:
Assistant's Email
Address:


BIO (used in the Syllabus and excerpts taken for verbal introduction)


TRAVEL
I am driving to and from the meeting location (skip ahead to ACCOMODATIONS)
I am FLYING to and from the meeting location (please complete Arrival/Departure info below)

ARRIVAL

Airport:      Airline:
Arrival date:      Flight Number      Arrival Time:

DEPARTURE
I DO / I DO NOT wish to be shuttled from the airport to the hotel and will arrange my own ground transportation
Airport:     Airline:
Departure date:      Flight Number:      Departure Time:


ACCOMMODATIONS
I have been told the CCD will make my room reservation at the resort.
OR
I understand I will be making my own room reservation at the resort. Click here for accommodation details and options.

Please complete the following in either case:
I will be checking in on
I will be checking out on