Salvation Church Ladies Retreat
Housing Form for Epworth By The Sea
May 5-6, 2023

Your Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Roommate(s) Name:
Roommates other than family, complete separate form.

Arrival Date: +

Departure Date: Date: +

Room Rates are per person, based on the room occupancy and include lodging for
1 night, 3 meals (Friday Supper through Saturday Lunch),
Georgia Motel fee and tax:
Please select from the following accommodations.

Pitts and Booth Motel:
Per Person for 1 Night and 3 Meals

Single (1 adult per room): $167.92

Double (2 adults per room): $117.30 per person

Quad (4 adults per room): $92.58 per person

COMMUTER FEE: $10 per person plus meals
Breakfast: $12.36 per person
Lunch: $20.22 per person

# of Commuter Tickets: $10 per person

# of Saturday Breakfast Meal Tickets:
$12.36 per person

# of Saturday Lunch Meal Tickets:
$20.22 per person

PLEASE INCLUDE TOTAL PAYMENT WITH RESERVATIONS

Number of Adults in Room *

I am paying for how many people? *

My room is being paid for by: *

Special Request (Diet, disability, etc):

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.

Name on Card

Credit Card Type

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 April 6, 2023 will forfeit $50.00 per person.
Any individual cancellation after April 29, 2023 will forfeit the full charges per person.

Please submit this form online or you may print and mail to:
Epworth By The Sea
Attn: Erica Bautista
P. O. Box 20407
St. Simons Island, GA 31522
Reservations must be made online.
For any additional information regarding accommodations,
contact Erica Bautista: ebautista@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 FOR RECORDS BEFORE SUMBITTING THIS FORM

Salvation Church Ladies Retreat Housing Form for Epworth By The Sea May 5-6, 2023

Room Rates are per person, based on the room occupancy and include lodging for 1 night, 3 meals (Friday Supper through Saturday Lunch), Georgia Motel fee and tax: Please select from the following accommodations.

COMMUTER FEE: $10 per person plus meals Breakfast: $12.36 per person Lunch: $20.22 per person