Public Health & Human Rights in the Era of AIDS International Symposium

April 7, 8 and 9, 2004

Mt. Washington Conference Center / Baltimore, Maryland

1/09/04

ON-LINE REGISTRATION FORM

Please complete and submit by Friday, January 23, 2004. Thank You!

Please fax to Molly McHugh, Symposium Coordinator, FAX # 011-410-614-8371

Family Name /
Given Name
Middle Name
Gender
Preferred Title of Address (Mr./Ms./Mrs./Dr./Other)
Country You are Representing at Symposium
Institution – Complete Name and Abbreviation
Job Title
Division/Department
Street Address
City
Country
Postal Code
Telephone (include country and city codes)
Fax (include country and city codes)
Work e-mail
Personal e-mail (optional)
I will attend dinner/keynote speech on Wednesday, April 7th (6:30 – 9:00)
I will attend full day conference on Thursday, April 8th (8:30 – 5:00)
I will attend evening reception on Thursday, April 8th (6:00 – 7:30 )
I will attend full day conference on Friday, April 9th (8:30 – 4:00)
Please describe any special needs.

On-line Registration Form (.pdf)

Please go to the website below, to download a .pdf version of the symposium registration form. You can enter information directly on this document and e-mail the completed form directly to Molly McHugh at the address given below. We request you complete your registration no later than Friday, January 23, 2004.

www.jhsph.edu/fogartyaids/phhr

Symposium Events

When you complete the on-line registration form, please indicate whether you will attend for each listed event. This will help us plan meals and logistics.

Wednesday, April 7 Dinner with Keynote Speaker (6:30 – 9:00 pm)

Thursday, April 8 Conference Sessions (8:30 am to 5:00 pm)

Evening Reception (6:00 to 7:30 pm)

Friday, April 9 Conference Sessions (8:30 am to 4:00 pm)

Conference Venue and Lodging

The symposium will be held at the Mt. Washington Conference Center (MWCC), which is located in the Mt. Washington neighborhood in Baltimore, Maryland. In addition to being the conference site, the MWCC also provides lodging: 48 standard rooms as well as 8 suites located in the historic Octagon building. All buildings are connected via a skywalk or underground passage. Some of the amenities are: business center, fitness center, game room, indoor walking track, scenic grounds, within walking distance to quaint shops and restaurants.

Room Rates

Standard Room is $109 per night plus lodging tax.

Contact the Front Desk of the MWCC directly to reserve your room by:

1. Phone: +011-410-578-7964

2. Fax: +011-410-578-4213 (please use hotel reservation form, e-mailed to you with

your invitation)
Cancellation Policy: you must cancel 24 hours before the date of your reservation, or else your credit card will be charged for the cost of one full night.

To find out more about lodging at the MWCC, please go to the website below:

http://www.mtwashconfctr.com/accommodations.html

Meals and Reception

The following meals will be provided: Wednesday Dinner, Thursday Continental Breakfast, Lunch and Reception (Cash Bar) and Friday Continental Breakfast and Lunch. On Thursday evening, participants my have dinner in the MWCC Cafeteria, walk 5 minutes to Mt. Washington Village to dine in one of the village’s restaurants or take a taxi to dine in some other Baltimore location, such as Fells Point or the Inner Harbor.

Please do not hesitate to contact me if you have any questions!

Molly McHugh

Symposium Coordinator

Tel: 410 955-8010 / E-mail:

Website: www.jhsph.edu/fogartyaids/phhr

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