Lady Bug Retreat
Epworth By The Sea • St. Simons Island, Georgia
Friday, November 10 - Sunday, November 12, 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.

Number of Adults in Room: *

My room is being paid for by: *

I am paying for how many people?: *

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:

Reynolds Court Motel
(2 Double Beds per room)

Single: $302.98

Double: $208.78 per person

Triple: $176.62 per person

Quad: $166.38 per person

Turner Lodge
(FULL - NO ROOMS AVAILABLE)

Single: $380.82

Double: $265.52 per person

Triple: $216.90 per person

Quad: $194.94 per person

Robertson Inn
(FULL - NO ROOMS AVAILABLE)

Single: $359.68

Double: $244.38 per person

Triple: $200.48 per person

Quad: $187.90 per person

Pitts/Booth
(FULL - NO ROOMS AVAILABLE)

Single: $326.84

Double: $225.62 per person

Triple: $186.40 per person

Quad: $176.16 per person

INDIVIDUAL FULL PAYMENT DUE WITH RESERVATION OCTOBER 10, 2023

Checks 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

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 October 28, 2023 will result in a forfeiture of $50.00 per person.
Any individual cancellation within 72 hours of arrival will result in a forfeiture of entire per person charge.

Please submit this form online, or you may print & 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,
please email Renthia Lewis at rlewis@epworthbythesea.org or call 912-638-8688.

PLEASE PRINT THIS FORM FOR YOUR RECORDS BEFORE SUBMITTING.

Lady Bug Retreat Epworth By The Sea • St. Simons Island, GeorgiaFriday, November 10 - Sunday, November 12, 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.

INDIVIDUAL FULL PAYMENT DUE WITH RESERVATION OCTOBER 10, 2023

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

Epworth Cancellation Policy: Any individual cancellation after October 28, 2023 will result in a forfeiture of $50.00 per person. Any individual cancellation within 72 hours of arrival will result in a forfeiture of entire per person charge.

**PLEASE PRINT THIS FORM FOR YOUR RECORDS BEFORE SUBMITTING.**

Lady Bug Retreat
Epworth By The Sea • St. Simons Island, Georgia
Friday, November 10 - Sunday, November 12, 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.

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

Epworth Cancellation Policy:
Any individual cancellation after October 28, 2023 will result in a forfeiture of $50.00 per person.
Any individual cancellation within 72 hours of arrival will result in a forfeiture of entire per person charge.

PLEASE PRINT THIS FORM FOR YOUR RECORDS BEFORE SUBMITTING.