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
**REMOTE PARKING WITH SOME SHUTTLE SERVICE PROVIDED**
What type of room(s) are you reserving?
$60 Family Suite - 2 rooms with 2 single beds each, sitting area, private bath, may bring sleeping bags
$35 Single Semi-private with shared bathroom (quad suite)
$35 Single Semi-private (sharing bathroom with one other)
$38 Handicap Accessible Private Single with private bath (small number available)
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.]
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.
Credit Card - (After submitting your credit card payment, RETURN TO THIS FORM to complete your registration.) To process secure payment, click on PLC ROOM button at
I am mailing a check with my registration for the conference. Please PRINT this form and send with check. St Nicholas Orthodox, 312 W Elm, Urbana, IL 61801
Name on Credit Card used (answer NONE if you paid with check)
A copy of your responses will be emailed to the address you provided.
Page 1 of 1
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service