Brookhaven Hotel Accommodations and Attendance Form

Please fill out the hotel accommodation form below!
First Name*
First
Last Name*
Last
Company*
Cellphone
Email*
Hotel Room on Wednesday, July 19, 2023, at the Holiday Inn \Brookhaven (Wednesday night hotel stay is NOT included in program tuition)*
- YES, Please put me on rooming list for a hotel room on Wednesday, July 19, 2023.
- NO, I do not need a hotel room on Wednesday, July 19, 2023.
Hotel Accommodations for Thursday, July 20, 2023 Holiday Inn \Brookhaven (Thursday night hotel stay IS included in program tuition).*
- YES, please put me on the rooming list for a hotel room on Thursday, July 20, 2023.
- NO, I do not need a hotel room on Thursday, July 20, 2023.
Brookhaven Session Attendance*
- I will be at attendance at the Brookhaven session
- I will miss the Brookhaven session due to a scheduling conflict

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