Post Critical Incident Seminar
Tuesday, September 6, 2022 - Friday, September 9, 2022
Epworth By The Sea
Attendee's First Name
Attendee's Last Name
Attendee's Email Address
Attendee's Phone Number
Rates are per person/per night including lodging,
meals (starting Tuesday Supper to Friday Lunch), gratuity and GA Motel Fee.
Rates are tax exempt. Payment must be made with a
state of Georgia check or credit card.
*Please upload Georgia Sales tax exemption and
hotel tax exemption forms with reservation below.
Tax Forms Upload
***Contact Renthia Lewis if paying with
personal check, credit card or out of state for rates.
Conference Dates: September 6-9, 2022
Single: $148.85 per night
Single: $135.15 per night
How are you making payment?
Personal payment by check or credit card
Additional Fee for Spouse
Who is paying for spouse?
*Spouse fees may be paid upon arrival.
Agency (tax exempt)
Self Pay (with tax)
Agency/County Contact Information
Agency Contact First and Last Name
Address Line 2
Pay by Check
Or Submit Credit Card Information Below:
AUTHORIZED USER OF CREDIT CARD
Credit Cards must be issued by the State of Georgia. State issued credit cards are tax exempt. Sales tax and hotel/motel tax exemption forms must accompany this form. Associations, booster clubs and personal methods of payments are not tax exempt.
Tax forms included
Name on Card
Amount To Charge:
Credit Card Type
*Attendee may pay their spouse additional night fees upon arrival
Expiration Date (mm/yy)
3 Digit Security Code:
Billing Street Address
Billing Address Line 2
Billing Zip Code
Billing Phone Number
Billing Fax Number
I declare that I have examined this GOVERNMENT AGENCY PURCHASE CARD and, to the best of my knowledge and belief, this payment is true and correct and made in good faith, pursuant to the sales and use tax laws of the State of Georgia. Further, I understand that any tangible personal property obtained under this certificate is subject to sales and use tax if the purchaser uses or consumes the property in any manner other than indicated above.
You will receive a confirmation once reservation is processed.
Full payment charged if cancellation received within 72 hours of arrival.
Please submit this form online or you may print and mail to:
Epworth By The Sea
Attn: Renthia Lewis
P. O. Box 20407
St. Simons Island, GA 31522
Reservations must be made online.
For any additional information regarding accommodations, contact
Renthia Lewis at email@example.com.
* CONFIRMATION OF YOUR RESERVATION WILL BE EMAILED OR MAILED 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.*