Newman Center Room Registration (early deadline 6/17/19...onsite $10 late fee)
ALL BEDS ARE SINGLE BEDS WITH SHEETS, PILLOW, BLANKET, TOWEL & WASHCLOTH PROVIDED

**FREE INTERNET**
**REMOTE PARKING WITH SOME SHUTTLE SERVICE PROVIDED**

Email address *
Last Name *
Your answer
First Name *
Your answer
Phone: *
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What type of room(s) are you reserving? *
Required
Specify FIRST and LAST NAME of preferred roommate(s) for single rooms with shared space. Additional roommates for singles of same gender will be randomly assigned. [Note: Roommate must register and pay separately before roommates guaranteed.]
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I acknowledge a room cancellation fee of $20, a fee if a key is not returned of $50, and a lost floor card key fee of $10. *
I acknowledge that no reservation will be held until payment is received. *
Type of Payment (You will receive an email receipt after you click SUBMIT at the bottom of this form) Call 217-840-8543 if you need assistance. *
Name on Credit Card used (answer NONE if you paid with check) *
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A copy of your responses will be emailed to the address you provided.
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