2023 ARHE/ARS/AAPG Annual Conference & HECAOD National Meeting LODGING RESERVATION FORM Today's Date: MM slash DD slash YYYY Name First Last Institution/Organization Name Email Phone number: For the person we can contact about this reservation*Based on your check-in and check-out dates: How many nights will you be staying?*Make a Selection12345Check-in date:* MM slash DD slash YYYY Check-out date:* MM slash DD slash YYYY Select A Room Type: Price is per night (all linens except for the pillows are included)*Make a selectionSingle Room - $85.00Double Room - $55.00$85/night for a single room $55/night for a double roomIs there a person who you would like to be your roommate: Please list their name Method of PaymentPlease make a selectionPayment by credit cardPayment by check or by POIf payment by check is selected, please list the complete address and contact person the invoice should go to:Total $0.00 Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name CAPTCHA
