Georgia Occupational Therapy Association
Thursday, October 26 - Sunday, October 29, 2023
Epworth By The Sea

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Rates are Per Room/Per Night and include lodging,
supper night of arrival through lunch on day of departure, tax, gratuity and the State of Georgia Motel Fee.

Turner Lodge
(FULL - NO ROOMS AVAILABLE)

Single: $199.60

Double: $140.77 per person

Tiple: $114.12 per person

Quad: $104.32 per person

Robertson Inn

Single: $187.86

Double: $130.21 per person

Triple: $105.91 per person

Quad: $98.45 per person

Pitts/Booth

Single: $174.96

Double: $122.00 per person

Triple: $100.04 per person

Quad: $93.76 per person

Number of Adults in Room *

Number of Children in Room with an Adult
(Child Ages 3-12) $28.65 each:

Number of Teens in Room with an Adult
(Teen Ages 13-17) $63.49 each:

Special Request (Diet, disability, sleeping accommodations, etc):

Roommate Request:
Roommate other than family, please complete separate form.

Arrival Date: +

Departure Date: Date: +

I am paying for how many people? *

My room is being paid for by: *

COMMUTER INFORMATION:
$5.76 per person (age 13 and up) per day (includes tax) plus meals.

Meal Prices with Tax and Gratuity:
Breakfast: $12.36
Lunch: $20.22
Supper: $24.72

# of Adults needing meal tickets

# of Children (ages 3-12) needing meal tickets (half price meals)

# of Teens (ages 13-17) needing meal tickets

Please check all meals your family needs a meal ticket for:
COMMUTERS ONLY

# of Adults commuting

# of Children (ages 3-12) commuting

# of Teens (ages 13-17) commuting

FIRST NIGHT'S RATE IS REQUIRED AS A DEPOSIT AND
THE BALANCE DUE MUST BE PAID UPON CHECK-IN.

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.

**WE DO NOT ACCEPT AMERICAN EXPRESS CREDIT CARDS.**

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:

Date +

Authorized Signature

clear

EPWORTH CANCELLATION POLICY:
After October 12, 2023, any individual cancellation will result
in forfeiture of first night’s lodging per person.
Cancellations within 72 hours of arrival will forfeit full charges.

Please submit this form online or you may print and mail to:
Epworth By The Sea
P. O. Box 20407
St. Simons Island, GA 31522
Reservations must be made online.
For any additional information regarding accommodations, contact Stephanie Sims:
ssims@epworthbythesea.org or 912-268-4835

* 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 YOUR RECORDS BEFORE SUBMITTING THIS FORM

Georgia Occupational Therapy Association Thursday, October 26 - Sunday, October 29, 2023Epworth By The Sea

Rates are Per Room/Per Night and include lodging,supper night of arrival through lunch on day of departure, tax, gratuity and the State of Georgia Motel Fee.

COMMUTER INFORMATION: $5.76 per person (age 13 and up) per day (includes tax) plus meals. Meal Prices with Tax and Gratuity: Breakfast: $12.36 Lunch: $20.22 Supper: $24.72

***FIRST NIGHT'S RATE IS REQUIRED AS A DEPOSIT ANDTHE BALANCE DUE MUST BE PAID UPON CHECK-IN.***

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.

EPWORTH CANCELLATION POLICY:After October 12, 2023, any individual cancellation will result in forfeiture of first night’s lodging per person.Cancellations within 72 hours of arrival will forfeit full charges.

Please submit this form online or you may print and mail to: Epworth By The Sea P. O. Box 20407 St. Simons Island, GA 31522Reservations must be made online. For any additional information regarding accommodations, contact Stephanie Sims: ssims@epworthbythesea.org or 912-268-4835

*PLEASE PRINT A COPY FOR YOUR RECORDS BEFORE SUBMITTING THIS FORM*