| Name(s): ___________________________________________________________________________ |
| |
Please PRINT your name(s) as you would like it/them to appear on your badge(s). |
| Address:____________________________________________________________________________ |
| City:_____________________________________________ State:_____________ Zip:____________ |
| Phone No.(___)_____________________________ E-mail:___________________________________ |
| Accommodations |
| |
 King Bed |
2 Double Beds |
NOTE: This is a SMOKE FREE hotel |
| Health Related Requirements |
| |
Refrigerator |
Handicap Accessible |
Hearing Impaired |
| |
Dietary Restrictions |
Other |
|
| |
__________________ |
__________________ |
|
| |
__________________ |
__________________ |
|
The charge for your room and tax will be charged to the National Grange. We will cover the nights of Sunday, November 9 thru Saturday, November 15, 2008. Should your stay include nights prior to the dates above, you will be responsible for the payment of those nights. Upon check-in, you will need to provide the hotel with a credit card for any incidental charges you may incur as well as any additional nights.
Arrival Date: _______________________________ Departure Date:_____________________________
I will be arriving by: Automobile Plane If by plane, number in party: ______
Flight Information (please fill in ALL blanks in this section)
If you are traveling by plane, please supply the following information regarding your coach class round trip airline ticket(s) to Hartford’s Bradley International Airport.
Your airport of departure AND last connection: _______________________________________
Arrival Time: ___________ A.M. or P.M. Airline:_______________ Flight No.:___________
Departure Time:_________ A.M. or P.M. Airline:_______________ Flight No.:___________ |
