Breakfree Butterfly 2025
Housing Registration Form • Epworth By The Sea
Thursday, May 1, 2025 - Saturday, May 3, 2025

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Church Group:

For Housing and Meals
Rates are per person, based on the room occupancy
and include lodging, meals and Georgia Motel Fee and tax.
Please check your choice:

2-night option: Meals include Thursday Supper through Saturday Lunch

Turner Lodge

Single: $413.08

Double: $286.04 per person

Triple: $232.74 per person

Quad: $208.44 per person

Robertson Inn:

Single: $391.96

Double: $264.92 per person

Triple: $216.32 per person

Quad: $201.40 per person

Number of Adults:

How Many in Room?

My room is being paid for by: *

Arrival Date: +

Departure Date: +

Special Request (Diet, disability, etc):

Roommate Name 1:

Roommate Name 2:

Roommate Name 3:

$100.00 deposit due with reservation.
Reservations and payments due by Thursday, May 1, 2025 and are subject to availability.
This event typically fills up quickly.

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

CARD NUMBER:

Amount To Charge:

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: +

Signature:

clear

How did you hear of this event? *

Epworth Cancellation Policy:
Any individual cancellation after Monday, April 21, 2025, will forfeit $50 per person; if you are sharing a room, your roommate's charges will increase after you cancel.
Any individual cancellation within72 hours of the group's arrival date will forfeit the first night charges per person; if you are sharing a room, your roommate's charges will increase for the second night.

Please submit this form online or you may print and mail to:
Epworth By The Sea
Attn: Trice Roberts
P. O. Box 20407
St. Simons Island, GA 31522
Reservations must be made online.
For any additional information regarding accommodations, contact Trice Roberts:
troberts@epworthbythesea.org or 912-638-8688.

* CONFIRMATION OF YOUR RESERVATION WILL BE 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!!

If you plan on attending but do not want to stay on property, please contact Trice Roberts, Group Reservations.
This form is for Epworth By The Sea ONLY.

PLEASE PRINT A COPY FOR YOUR RECORDS BEFORE SUBMITTING ONLINE.

Breakfree Butterfly 2025 Housing Registration Form • Epworth By The Sea Thursday, May 1, 2025 - Saturday, May 3, 2025

** For Housing and Meals** Rates are per person, based on the room occupancyand include lodging, meals and Georgia Motel Fee and tax. Please check your choice: