Lodge (required):

Member Number (required):

Address (required):

City (required): State (required): Zip (required):

Phone Number (for credit card information - required):

E-mail address:

Spouse/Guest (required if applicable):

Member: (yes or No)

Arrival Date (one arrival date must be checked)

Monday      Tuesday      Wednesday      Thursday      Friday      Saturday

Departure Date (one departure date must be checked)

Friday      Saturday      Sunday

Sleeping Room Request:

1 Bed       2 Beds      

Handicapp Room Request:

1 Bed       2 Beds      

Special Handicapp Needs:

Hospitality Room Request:

Sleeping Room w/bed removal:

Sleeping Room w/o bed removal:

Suite:

Pavilion:

Other:

Responsible Party (Required):
(Responsible party must send check, money order or credit card by U. S. Mail to the Housing Chairman. Please make check or money order payable to the hotel.)