

| Standard - Single/Double: | $120.00 + 10.63% tax |
| Club - Single/Double: | $140.00 + 10.63% tax |
| Additional Adult: | $10.00 + 10.63% tax |


| Name: |
| Organization or Affiliation: |
| Organization Address: |
| Organization Telephone: |
| City: | State: | Zip: |
| Country: | FAX: |
| Room type desired: |
| ____ | King bed | ____ | Two double beds |
| ____ | Non-smoking room | ____ | Smoking room |
| ____ | Club Level |
| Arrival: | Departure: |
| I have the following special needs: |
| To guarantee with credit card: (please complete the following information) |
| Visa | Master Card | Amex | Diners | CarteBlanche | (Circle one) |
| Card Number: |
| Expiration date: |
| Print Name as shown on credit card: |
| Signature: |