The Westin Copley Place
Boston, Massachusetts

Wednesday, April 30, 2003
Thursday, May 1, 2003

Please complete this form and return it with your check to the address below AS SOON
AS POSSIBLE. 

Your registration should reach us by 20 April 2003. If you cannot get a check to us by that
 date or if you  wish to register onsite, please contact us in advance of the meeting so we
 can include you in the head  counts for refreshment breaks and the luncheon.

A preliminary program is included in this mailing and is also available at

http://www.anes.uab.edu/aneshist/aha2003.htm 

AHA2003 Registration Fees [checks payable to Anesthesia History Association]:

AHA Member: $60 USD ___________

Non-member: $80 USD ___________

Registration includes Wednesday evening reception [cash bar], all Thursday paper sessions and 

refreshment breaks and Thursday luncheon.

Please check here if you will attend Wednesday morning tour. ($20 USD) _____

Please check here if you will attend Wednesday afternoon tour. ($20 USD) ____

Total (registration fee and tours): $_____________

 

NAME: ______________________________

ADDRESS: __________________________

                     __________________________