Memory Maniacs
Housing Registration Form
Wednesday, January 31, 2024 - Monday, February 5, 2024
Epworth By The Sea • St. Simons Island, Georgia

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Rates listed below are per person based on the number of adults staying in the room together, and include 1 night lodging, 3 meals, state of Georgia motel fee and taxes.
PLEASE SELECT FROM THE FOLLOWING ACCOMMODATIONS:

Turner Lodge
Lodging for 1 nights and 3 meals

Single (1 adult per room): $201.95 per night

Double (2 adults per room): $143.12 per person per night

Triple (3 adults per room): $115.30 per person per night

Quad (4 adults per room): $104.32 per person per night

Robertson Inn
Lodging for 1 nights and 3 meals

Single (1 adult per room): $190.21 per night

Double (2 adults per room): $132.56 per person per night

Triple (3 adults per room): $107.08 per person per night

Quad (4 adults per room): $98.45 per person per night

Pitts/Booth:
Lodging for 1 night and 3 meals

Single (1 adult per room): $177.30 per night

Double (2 adults per room): $124.34 per person per night

Triple (3 adults per room): $101.21 per person per night

Quad (4 adults per room): $93.75 per person per night

Roommate Name:

Number Adults in Room:

I am paying for how many adults?

My room is being paid for by: *

Arrival Date: +

Departure Date: Date: +

Special Request (Diet, disability, etc):

HOTEL RESERVATIONS:
First night due with individual reservation.
Balance due upon check-in.
Make check payable to Epworth By The Sea

Check #:

Check Amount:

Or Submit Credit Card Information Below:
There is a 3% Credit Card Transaction Fee on payments over $1,000.

**WE DO NOT ACCEPT AMERICAN EXPRESS CREDIT CARDS.**

Name on Card

Credit Card Type:

Visa

MasterCard

Discover

Amount To Charge:

CARD NUMBER:

Expiration Date (mm/yy)

3 Digit Security Code:

Billing Address Zip Code:

Authorization:

I am authorized to make these credit card charges:

Today's Date +

Authorized Signature

clear

EPWORTH CANCELLATION POLICY:
Any individual cancellation after Wednesday, January 17, 2024
will forfeit $40 per person.
Any individual cancellation within 72 hours upon arrival
will forfeit the first night's charges per person.

Please submit this form online or you may print and mail to:
Epworth By The Sea
Attn: Trice Roberts
P. O. Box 20407
St. Simons Island, GA 31522
Reservations must be made online.
For any additional information regarding accommodations,
contact Trice Roberts: troberts@epworthbythesea.org or call 912-638-8688.

* 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.

PLEASE PRINT A COPY OF THIS FORM FOR YOUR RECORDS BEFORE SUBMITTING.

Memory Maniacs Housing Registration Form Wednesday, January 31, 2024 - Monday, February 5, 2024 Epworth By The Sea • St. Simons Island, Georgia

Rates listed below are per person based on the number of adults staying in the room together, and include 1 night lodging, 3 meals, state of Georgia motel fee and taxes. PLEASE SELECT FROM THE FOLLOWING ACCOMMODATIONS:

HOTEL RESERVATIONS:First night due with individual reservation.Balance due upon check-in.Make check payable to Epworth By The Sea

Or Submit Credit Card Information Below: There is a 3% Credit Card Transaction Fee on payments over $1,000.