Lodging Reservation Form (Reservation Deadline: Wednesday, May 1, 2002)

Millennium Knickerbocker Hotel Chicago
163 East Walton Place, Chicago, IL 60601-1527 (Attn: Reservations)
Phone: 1-800-621-8140 (within continental U.S.); (00)1-312-751-8100 (outside continental U.S.)
Fax: (00)1-312-751-0370

3rd International Symposium on Serpin Biology, Structure and Function (Code UIIIC)
June 2-5, 2002, Chicago

Reservations can be made by mail, phone, or fax. For mail or fax reservations, complete this form and return to the hotel. To reserve a room by phone, call the hotel directly and be sure reference room block code UIIIC. For security purposes, please do not submit this form via Internet.

GUEST INFORMATION

Last Name First Name Middle Initial

Street Address Apartment Number

City State

Country Postal Code

Daytime Phone E-mail Address

CREDIT (CARD) INFORMATION

A credit card is required to confirm/guarantee your reservation. Note that if the credit card holder is someone other than the guest,
that individual must submit a credit card authorization form, along with a photocopy of the front and back of the credit card.

Credit Card Type                         Cardholder Name (if different from above)

Card Number       Expiration Date

Cancellation Policy: The Hotel requires 48-hour cancellation notice to avoid a charge of the first night's room and tax.

RESERVATION INFORMATION

Rates: $195, single or double occupancy. The charge for each additional occupant is $20. All rates are per night and subject to prevailing taxes (currently 14.9%).

Enter travel dates, space requirements and preferences. Preferences are not guaranteed until check-in.

Arrival Date               Departure Date

Number of Rooms         Number of Adults          Preferred Bed Type:   one bed two beds

Special requirements (please specify)