Attention: Reservation for AMCIS 2000
1126 Queens Highway, Long Beach, California 90802
Phone: (562)435-3511    Fax: (562)437-4531

Single
$ 125.00
Double
$ 125.00

Please complete the information below and then print the form using the menu button.
Either fax to the above number or mail the form to the hotel.

Personal Information:
Title: Mr. Mrs. Ms.
First Name:      M.I.
Last Name:
Address:
City:  State:  Zip Code:
Country:
Phone:
Email:

Arrival and Departure Dates:
Arrival Date:
Departure Date:
Preferences:
Number of Guests Per Room:
If Double Occupancy:
              sharing with:
First M.I.
Last
Bedding:
Smoking:
Additional Information
Please enter your mileage program (if any) and your membership number below .
Account Name
Account Number
Group Code
Credit Card Information:
Type of credit card:
Name on card:
Number:
Expiration Date: /