2011 Capital Challenge 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:

Number of People:
Arrival Date (mo/day/yr):	*
Departure Date (mo/day/yr):	*
Hotel (Choice #1):
Hotel (Choice #2):
Number of Rooms:	*
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.
If you do not leave a credit card, your room will not be guaranteed.
Check the information that you have just entered, and make changes if necessary. When you are satisfied that everything is correct, press the SUBMIT button.
A confirmation will be emailed to you. If your hotel choices 1 & 2 are sold out, we will notify you.