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Hawaiian Eye 2010 Grand Hyatt Kauai Resort & Spa January 17-22, 2010 MEETING SPACE REQUEST FORM *Functions cannot conflict with any official Hawaiian Eye 2010 educational activity or event. Please note there is a $500 charge for space requests

Please return the completed form no later than November 18, 2009

Company Name: Contact Name: P:

F:

Email:

Date of Function: Name of Function: Purpose:

  • #

    of people:

Room Set-Up:

(day, date, set-up time)

AV Requirements:

Food Service to be Provided:

Breakfast

Lunch

Dinner

Cocktails

Snacks

Other

None

Function Is:

Open

Restricted

Space Request Cost - $500

Payment Information

  • Enclosed is my check payable to “Hawaiian Eye 2010” paid in U.S. dollars, drawn on a U.S. bank.

  • Please bill my (Circle one):

Visa

MasterCard

American Express

Account Number

_______________________________

Exp. Date

___________

3-4 Digit Security Code

_______________

Signature

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Date Requested:

Return Requests to: Hawaiian Eye 2010 Attn: Megan Stewart 6900 Grove Road, Thorofare, NJ 08086

T: 856-848-1000 ext. 239

F: 856-848-6091

Email: hawaii2010@ocularsurgerynews.com

Internal Use Only Date Approved: Room Assigned: Function Day/Date/Time: Authorization:

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