Kaplan Medical Guestroom Reservation Confirmation with Hotel Information (2nd tab)

Guest Name (Last, First) Arrival Date Departure Date Room Type Rate (To be completed by Club Quarters)

2013 Rates
Club Prices do not include tax and are guaranteed through December 31, 2012. Step 1 Live; 7 Week Program; 50 nights Room Type Rate per night March 18 to Nov 17 $76 Rate per night other dates $61 Clinical Skills; 6 to 7 nights Room Type Nightly Rate: March 18 to Nov 17 $96 Rate per night other dates $96

Phone # Email address Credit Credit (for guarantee). Guest needs to present a credit card upon Registration. If 3rd party paying, please complete form in Tab #3.

Club

Club

Type: CC #: Exp:
Step 2 Live; 6 week program; 43 nights Room Nightly Rate per Type Rate: night March 18 other to Nov 17 dates Club $76 $61 Step 1 14 Week; 99 nights Room Rate per Rate per Type night night March 18 other to Nov 17 dates Club $79 $64

Comments/Requests Confirmation # (To be completed by Club Quarters)

There is a multiple occupancy surcharge of $ 15.00 per person per night for guests over 12 years of age No penalty for cancelations made by 12 noon day prior to arrival. Cancellations/Changes made from 12 noon local hotel time the day prior to arrival will incur a $35.00 USD cancellation/change fee.

Step 3 Live; 12 day program; 13 nights Room Rate per Rate per Type night night March 18 other to Nov 17 dates Club $99 $99

Step 1 16 Week; 112 nights Room Rate per Rate per Type night night March 18 other to Nov 17 dates Club $79 $64

Cancellations/Changes made after 12 noon local hotel time the day of arrival are charged one night plus room and tax. Cancellations/Changes made less than 72 hours prior to date of arrival for 30 day stays will incur a penalty equal to 100% of first three nights. Pre-payment is required at registration for all reservations booked for 30-days or more.

Club Quarters, Central Loop

111 West Adams Street Chicago, IL 60603 Tel: 312.214.6400 Fax: 312.601.3300
Located in the center of the Central Loop, which is Chicagos business and financial district. Near LaSalle and next to the Rookery, it is a short walk to the Symphony Center, Art Institute, Board of Trade, Willis Tower (formerly known as the Sears Tower) and Grant Park. Club Quarters, Central Loop features the popular Elephant & Castle Pub and Restaurant, serving a combination of British classics and North American favorites. Club Quarters offers a choice of accommodations for the business travelers needs: guest rooms, Corporate Apartments and meeting space. Number of Guest Rooms: 320; Corporate Apartments: 17; Meeting Rooms: 7

Features and Amenities

Full service hotel for the private use of member organizations Restricted entry for greater security Instant check in/check out 24-hour Member Service Desk/Concierge Free high-speed Internet access throughout the building Private Club Living Room with complimentary coffee, newspapers and magazines Free use of a computer and network printing Restaurant, Bar and Meeting Space Food/beverage service in Club Living Room Fitness Room Valet or self service launderette Free chilled, purified bottled water Latest design workstation with task lighting and ergonomic chair 2-line speaker and cordless phones, voicemail and direct dial number Cable/satellite TV Luxury bedding and linens Room Service 24hr multi-menu delivery Shopping services/Refrigerator stocking Coffee/Tea maker Alarm clock radio with iPod docking station Hair dryer/Make-up mirror Refrigerator/microwave available upon request

If you would like to stay a different number of nights than is standard for the program, please contact Member Services at 203-905-2100 and mention Kaplan. For assistance during your stay at Club Quarters, Central Loop in Chicago, you may contact the Member Service Desk at any time, by dialing "zero" from the guestroom, or 312-601-3333, from an outside line.

The Smart Hotel for the Sensible Traveler New York Washington, D.C. Boston Philadelphia Chicago London San Francisco Houston

Third Party Authorization Form

I authorize Club Quarters to charge my credit card for the charges accrued by the following guest(s): Name of Guest(s): Company Name: Confirmation Number(s): Arrival Date: _________________ _______________________________________ _______________________________________ _______________________________________ Departure Date: _____________

Check one :

Room & Tax All only*: Charges: __________ ____________

*Any incidental charges not paid by the guest at check out will be the responsibility of the credit card holder below.

Indicate which location :

____ New York: Midtown (off Fifth Avenue) ____ New York: Rockefeller Center ____ Boston: (near Post Office Square) ____ Chicago: Wacker at Michigan ____ Houston: (off Rusk and Main Streets) ____ London: Gracechurch (in the City) ____ London: Trafalgar Square ____ New York: Wall Street (off Wall Street) ____ Washington, DC: (on Farragut Square) ____ Philadelphia: (opposite Liberty Place) __x__ Chicago: Central Loop (near LaSalle) ____ San Francisco: (across from Embarcadero Center) ____ London: St.Pauls (in the City)

Credit Card Information:

Name on Credit Card: Credit Card Number: Expiration Date: _________________________________________ _________________________________________

_____________________________________

Cardholder Information :
Billing Address: __________________________________________ __________________________________________ Cardholder Telephone Number: Signature of Card Holder: ________________________________________ _________________________________________

Required with all completed Copy forms: of the credit card (front and back) Copy of valid identification from the cardholder