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Scientific Summit - Room Sharing

Completion of this form will add your name, contact information, and preferences to a list of Summit attendees who are looking to share a room.

Please complete this form by January 24.

It is the responsibility of the individual to contact anyone with whom they wish to share a room. The use of this form is purely optional and does not guarantee a room share. APS, the Board of Directors, and staff assume no responsibility with respect to these services and accept no liabilities relative to the services. Submission of this form indicates your acknowledgement and acceptance of this disclaimer of liability. Questions? Contact info@americanpainsociety.org

First Name(*)
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Last Name(*)
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Company or Institution(*)
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City(*)
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State(*)
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Phone(*)
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Email(*)
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Arrival Date(*)

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Departure Date(*)

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I identify as(*)
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I prefer a roommate who identifies as(*)
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Please confirm you are not a robot and type the letters below. (*)

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