2009 Southeastern Charity Online Reservation Form



Name:	*
Email Address:
(We respect your privacy and will not give your email address to any third party)
Organization (if applicable):
Mailing Address:	*

City:	*
State / Province:	*
Zip / Postal Code:	*
Daytime Phone Number:	*
Fax Number:

Arrival Date (mo/day/yr):	*
Departure Date (mo/day/yr):	*
Number of Rooms:	*
Hotel (Choice #1):
Hotel (Choice #2):
Room Type:
King / Queen
2 Doubles
Room Preference:
Smoking
Non Smoking

Method of Payment
Credit Card Number	*
(Your credit card will not be charged. This is to guarantee a hotel reservation only.)
Expiration Date	*
Cardholders Name (as it appears on card):	*

* Denotes required fields.

A confirmation will be emailed to you. If Hotel Choice 1 & 2 are sold out, we will email you options.