RESERVATION FORM

Please E-Mail or Fax To: Sharon Hubenak, Director, Recruitment and Residency

Department of Health Care Administration

Trinity University

One Trinity Place, # 58

San Antonio, Texas 78212-7200

E-MAIL: hca@trinity.edu FAX: 210-999-8108 OFFICE: 210-999-8107

NAME: ________________________________________________

TITLE: ________________________________________________

ORGANIZATION: ________________________________________________

STREET ADDRESS: ________________________________________________

CITY/STATE/ZIP: ________________________________________________

TELEPHONE: ________________________________________________

FAX: ________________________________________________

E-MAIL ADDRESS: ________________________________________________

YES NO I will attend the Preceptors’ Conference on Friday, April 13.

YES NO I will attend the dinner on Thursday, April 12.

YES NO My guest/spouse will join me for the dinner.

Name: ________________________________________

YES NO A representative from my institution will attend the conference.

Name: ________________________________________

YES NO My representative will attend the dinner.

YES NO My representative will bring a guest/spouse to the dinner.

Name: ________________________________________

NOTE: Normal interview times run until 5 p.m. on Friday, April 13. If you have time constraints

due to your travel plans, please let us know so that we can make arrangements to

accommodate you.