Valdosta South District
Epworth By The Sea • St. Simons Island, Georgia
Thursday, April 13, 2023 - Saturday, April 15, 2023

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Arrival Date: +

Departure Date: Date: +

Roommate(s) Name:
Roommate other than family please complete separate form.
Roommate form MUST BE SUBMITTED ON THE SAME DAY as this form!

Check box if Roommate will pay separately:

Roommate pays separately

Number Adults in Room: *

My room is being paid for by: *

I am paying for how many people?: *

Number of Children in Room:
(Ages 3-12 years)

Number of Teens in Room:
(Ages 13-17 years)

Special Request (Diet, disability, etc):

Rates are per person based on the number of adults in each room, and include
2 nights, 6 meals, tax, and state of Georgia motel fee.

PLEASE CHECK APPLICABLE RATES:

Robertson Inn
Adult Rate

Single: $368.68

Double: $253.38 per person

Triple: $209.48 per person

Quad: $196.90 per person

Child (Ages 3-12 years)
*In room with adult(s).

$57.30 per child

Teen (Ages 12-17 years)
*In room with adult(s).

$126.98 per teen

PLEASE INCLUDE TOTAL PAYMENT WITH RESERVATION
Make check payable to Epworth By The Sea

Check #:

Check Amount:

Or Submit Credit Card Information Below:
Online reservations must be paid for by credit card only.
There is a 3% Credit Card Transaction Fee on payments over $1,000.

Name on Card

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 Group Cancellation Policy:
Full payment due with reservation by Tuesday, February 28, 2023.
Any cancellation after Tuesday, February 28, 2023, will forfeit $50 per person.
Any cancellation within 72 hours of arrival will result in the forfeiture of the entire charges per person.

Please submit this form online, or you may print & mail to:
Epworth By The Sea
Attn: Kelly Maloy
P. O. Box 20407
St. Simons Island, GA 31522
Reservations must be made online.
For any additional information regarding accommodations,
please email Kelly Maloy at kmaloy@epworthbythesea.org or call 912-638-8688.

PLEASE PRINT THIS FORM FOR YOUR RECORDS BEFORE SUBMITTING.

Valdosta South District Epworth By The Sea • St. Simons Island, GeorgiaThursday, April 13, 2023 - Saturday, April 15, 2023

Rates are per person based on the number of adults in each room, and include 2 nights, 6 meals, tax, and state of Georgia motel fee.

PLEASE INCLUDE TOTAL PAYMENT WITH RESERVATIONMake check payable to Epworth By The Sea

Or Submit Credit Card Information Below:Online reservations must be paid for by credit card only. There is a 3% Credit Card Transaction Fee on payments over $1,000.