Post Critical Incident Seminar
Monday, April 10, 2023 - Thursday, April 13, 2023
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 Monday Supper to Thursday 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.
rlewis@epworthbythesea.org

Conference Dates: April 10-13, 2023

Checkin: +

Checkout: +

Robertson Inn

Single: $146.75 with tax exemption

How are you making payment?

Personal payment by check or credit card

Agency/County payment

Spouse's name:

Additional Fee for Spouse

$175.00

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

Agency Name

Street Address

Address Line 2

City

State

Zip Code

Phone Number

Email Address

Pay by Check

Check #:

Check Amount:

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

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

Agency Name

Amount To Charge:

Credit Card Type

*Attendee may pay their spouse additional night fees upon arrival

CARD NUMBER:

Expiration Date (mm/yy)

3 Digit Security Code:

Billing Street Address

Billing Address Line 2

Billing City

Billing State

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.

Today's Date

Signature

clear

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 rlewis@epworthbythesea.org.

* 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.

Post Critical Incident SeminarMonday, April 10, 2023 - Thursday, April 13, 2023Epworth By The Sea

***Contact Renthia Lewis if paying with personal check, credit card or out of state for rates.rlewis@epworthbythesea.org