Atlas International Symposium
The "W" Hotel - Seattle, Washington
October 3rd -6th, 2013

Attendee Registration Form

Please fill out the form below for each attendee.

Registration due date for early bird rates - Sept 4^th.

Registration for attendees is $250 for "early bird" registrants and $400 after Sept 4th

Registration for spouses – $200.00/Early Bird is $125.00

Attendee Information

Registration Type Agent Overseas Agent Licensee Sponsor


First Name		Last Name
	(enter name as it appears on drivers license, passport or other identification)

Agent Name		Agent No.

Address 1
Address 2
City
State		Zip Code
Country
Phone

E-Mail
	(Please enter the email address that should receive pre-Symposium and onsite Symposium information)

Hotel Information

Hotel Required? Yes No


Arrival Date
Departure Date
# of guests

Room Type King 2 Queens Other
Attendees - you can access the site to learn more about the event and to book, modify, or cancel a reservation now to October 9, 2013. Our room block allows for early arrivals and late departures Atlas International Symposium (OR copy and paste the following link into a web browser) https://www.starwoodmeeting.com/Book/atlasintl Our room rate at the "W" is $175 USD per night.
(If choosing "other", please call WHO for suite types, prices and availability)

Special Room Requests
	Room rates are subject to current taxes per room per night.

	A credit card is required to guarantee your room. A Credit Card Release Form will be required, or you can call Atlas Travel - 800-446-2077 - with your credit card information.

Pricing, Payment and Other Details	Cancellation of room must be made with Atlas World-Class Travel 7 days prior to arrival or one night's room will be charged to your credit card. Check-in time is 3:00 p.m. and check-out time is Noon. Special requests for adjoining rooms, suites, etc., will be requested but cannot be guaranteed. Bedding requests are based on availability.

	Agents: Our IAM sub-block is now full. We are no longer able to offer rooms at the Fairmont Pacific Rim.

Name Badge Information

Anyone attending food functions or social events needs a name badge. Please list each person in your party who will register for the Convention as their name badge should appear. Include ages of children under age 18 only. All guests will be billed as an adult unless ages of children are included.
	First Name	Last Name	Age (if under 18)
Attendee 1
Attendee 2

Questions?

Convention Registration:
Natalie Endres ( nendres@atlasintl.com) | 888-669-6031 ext. 4104

888-669-6031