Name(Required) First M.I. Last Cell Phone(Required)Email(Required) Alternate Contact Person – Full NameIn case of an emergencyAlternate Contact – PhoneAlternate Contact – Email LodgingReservations will be arranged for you by the WV Perinatal Partnership at the Morgantown Marriott at Waterfront Place, Morgantown, West Virginia. Unless otherwise arranged, one night’s lodging will be provided to speakers who have to travel more than 60 minutes (one-way). Please reply by October 5, 2026, to secure lodging.Please secure lodging for:(Required) Tuesday – November 3rd, 2026 Wednesday – November 4th, 2026 Thursday – November 5th, 2026 Friday – November 6th, 2026 I do not require lodging Attendance for 2026 WV Perinatal Summit As a speaker at the 2026 WV Perinatal Summit, you receive a free registration for the full conference. Please indicate below your plans to participate and we will register you.I will attend the Summit on:(Required)Thursday, November 5thFriday, November 6thBoth Days – Thursday and FridayOtherAttendance – OtherPlatinum Anniversary Celebration Banquet You are cordially invited to our 20th Anniversary Celebratory Banquet on Thursday, November 5th. If you plan to attend, please provide your entree choice below.Entree Choice(Required)Not AttendingSteakSalmonVegetarianDo you have any dietary restrictions, allergies, or special meal requirements?You are welcome to bring a guest. If you do, please provide their name and entree choice:Guest Name (for name tag)Guest Entree Choice(Required)Not AttendingSteakSalmonVegetarianDo they have any dietary restrictions, allergies, or special meal requirements?TransportationThe West Virginia Perinatal Partnership will cover your travel expenses including meals incurred during travel, flights/mileage/car rental if applicable, and other miscellaneous expenses incurred (i.e. baggage fees, parking, etc.). Depending on individual circumstances we are happy to discuss any additional travel expenses/lodging needs that you may incur.Please maintain your receipts from your travels to be submitted at the conclusion of the Summit.You will receive an email from Eleanor Chin (echin@wvperinatal.org) with the travel reimbursement form and instructions.Anticipated Travel Method(Required)Select all that apply Personal Vehicle Rental Vehicle Flight If traveling by air, you will be contacted by Eleanor Chin to assist in selecting your flight and arranging airport transportation. Nearby Airports Drive time to Morgantown Marriott at Waterfront Place Morgantown Municipal Airport (MGW), Morgantown, WV 11 minutes (3.8 miles) Pittsburgh International Airport (PIT), Pittsburgh, PA 1 hour 19 minutes (78.5 miles) North Central WV Airport (CKB), Bridgeport, WV 36 minutes (31.3 miles) Anticipated Arrival – Date/Time(Required)Anticipated Departure – Date/Time(Required) Δ