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Please note that the minimum requirement of 30 guests must be met to receive a Hotel Group Rate.

* Group Name/Organization:

* Name:


FIRST		LAST

Address 1:

Address 2:

City,State,ZIP:


CITY		STATE		ZIP

Phone:

ex. xxx-xxx-xxxx

Fax:

ex. xxx-xxx-xxxx

* Email:

* Date(s):


CHECK IN		CHECK OUT

* # of Rooms:

* # of Guests:

(Minimum — 30)

Hotel Specifications (ex: require swimming pool, laundry facilities, late checkout):

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