GEORGIA ADDICTION COUNSELORS ASSOCIATION
Housing Registration Form
Friday, April 8 – Monday, April 11, 2022
Address Line 2
** Package Rates Are Per Person, based on room occupancy,
and include lodging for 3 nights, 9 meals, state of Georgia motel fee and taxes. **
1 Adult Per Room: $546.60
2 Adults Per Room: $371.64 per person
1 Adult Per Room: $511.71
2 Adults Per Room: $340.23 per person
1 Adult Per Room: $473.34
2 Adults Per Room: $315.81 per person
My room is being paid for by:
Departure Date: Date:
Special Request (Diet, disability, etc):
Or Submit Credit Card Information Below:
Name on Card
Credit Card Type
Amount To Charge:
Expiration Date (mm/yy)
3 Digit Security Code:
Billing Address Zip Code:
I am authorized to make these credit card charges:
Cancellations after March 11, 2022 will forfeit $40.00 per person
Cancellations after March 25, 2022 will forfeit the first night's charges per person.
Cancellations after April 1, 2022 will forfeit the full charges per person.
Please submit this form online. Print & FAX to 912-634-0642, or mail to:
Epworth By The Sea
P. O. Box 20407
St. Simons Island, GA 31522
Reservations must be made by reservation form.
For any additional information regarding accommodations, contact Tiffany Flavell:
email@example.com or 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.*