Pheasants Forever
National Youth Leadership Council
Epworth By The Sea • St. Simons Island, Georgia
Wednesday, July 13, 2022-Sunday, July 17, 2022

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Arrival Date: +

Departure Date: Date: +

Number 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
1 night, 3 meals, tax, and state of Georgia motel fee.

PLEASE CHECK APPLICABLE RATES:

Pitts / Booth

Single: $160.01

Double Per Person: $107.50

Triple Per Person: $85.73

Quad Per Person: $79.50

Number of Children in room with adult – child (3-12 years) $22.26

Number of Teens in room with adult – teen (13-17 years) $50.34

PLEASE INCLUDE TOTAL PAYMENT WITH RESERVATION
Make check payable to Epworth By The Sea

Check #:

Check Amount:

Or Submit Credit Card Information Below:
Online reservations must be paid for by credit card only.

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:
Full refund prior to June 29, 2022.
After July 9, 2022, any individual cancellation will result in forfeiture of $40 per person.
Cancellations within 72 hours of arrival will forfeit first night’s charge.

Please submit this form online, or you may print & 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,
please email Trice Roberts at troberts@epworthbythesea.org or call 912-638-8688.

PLEASE PRINT THIS FORM FOR YOUR RECORDS BEFORE SUBMITTING.

Pheasants Forever National Youth Leadership Council Epworth By The Sea • St. Simons Island, GeorgiaWednesday, July 13, 2022-Sunday, July 17, 2022

Rates are per person based on the number of adults in each room, and include 1 night, 3 meals, tax, and state of Georgia motel fee.

PLEASE INCLUDE TOTAL PAYMENT WITH RESERVATIONMake check payable to Epworth By The Sea

Or Submit Credit Card Information Below:Online reservations must be paid for by credit card only.