Winter Conference 2019
Housing Registration Form • January 29 - February 1, 2019
Sponsored by Epworth By The Sea
2.5 CEU Credit Available

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Package Rates Are Per Person
Lodging for 3 nights, 9 meals, state of Georgia motel fee, taxes, and programming fee
are included in the rates. Please check your choice:

REYNOLDS PER PERSON SINGLE - $388.89

REYNOLDS PER PERSON DOUBLE - $284.64

PITTS/BOOTH PER PERSON SINGLE:- $420.00

PITTS/BOOTH PER PERSON DOUBLE - $305.37

OFF CAMPUS FEE - Guests staying off campus, must pay the programing fee to attend the conference. This fee includes lunch at Epworth Wednesday, Thursday and Friday. $115.00

How Many in Room?

Number of Adults (18+)

How Many Children (3-12 yrs = $57.90 per child)

My room is being paid for by:

I am paying for how many people?

Arrival Date: +

Departure Date: Date: +

Special Request (Diet, disability, etc):

Roommate Name:

Submit form with $75 per person deposit or full payment to: Epworth By The Sea.

Check #:

Amount: $

Or Submit Credit Card Information Below:

Name on Card

Credit Card Type

Amount To Charge: $

Credit Card Number

Expiration Date (mm/yy)

3 Digit Security Code:

Billing Address Zip Code:

I am authorized to make these credit card charges: *

I Am Authorized

NA

2.5 CEU Registration Form:

First Name

Last Name

Street Address

Address Line 2

City

State

Zip Code

Church

Full refund for cancellations made by January 1, 2019.
Cancellations after January 15, 2019, forfeit $75.00 per person.

Please submit this form online, or you may print & FAX to 912-634-0642, or mail to:
Epworth By The Sea
P. O. Box 20407
St. Simons Island, GA 31522
Email:kmaloy@epworthbythesea.org

* CONFIRMATION OF YOUR RESERVATION WILL BE MAILED OR EMAILED TO YOU *
No phone reservations accepted. No pets or alcohol. Check in: 4:00 p.m. - Check out 11:30 a.m. Sometimes great opportunities are missed when too many people wait until the last minute to register. We cancel undersubscribed events so please register early. We don't want to cancel what you want!!
This form is for Epworth By The Sea ONLY.

Winter Conference 2019 Housing Registration Form • January 29 - February 1, 2019Sponsored by Epworth By The Sea 2.5 CEU Credit Available

** Package Rates Are Per Person** Lodging for 3 nights, 9 meals, state of Georgia motel fee, taxes, and programming fee are included in the rates. Please check your choice: