GA Addiction Counselors Association
Epworth By The Sea • St. Simons Island, Georgia
April 7-10, 2019

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Check box if Roommate will pay separately:

*Room Registration is per person per night, and includes meals beginning with supper on day of arrival and goes through lunch on day of departure, and all taxes.
~ PLEASE SELECT FROM THE FOLLOWING ACCOMMODATIONS ~


Child Rate in room with adult ages 3-12 years: 19.84 per night
Teen Rate in room with adult $45.44

PLEASE INCLUDE TOTAL PAYMENT WITH RESERVATIONS.
If you have a roommate paying separately,
a separate Reservation Form must be filled out and submitted ON THE SAME DAY
Checks payable to Epworth By The Sea

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


* If you are paying with a State of Georgia credit card and will be tax exempt,
please fill out the Purchase Order Credit Card Authorization Form below.

I am authorized to make these credit card charges:

Epworth Cancellation Policy:
Full payment due with reservation by March 20, 2019
Any cancellation after March 20, 2019 will result in forfeiture of $40.00 per person.
Any cancellation within 72 hours of arrival will result in forfeiture of entire per person charge

Please submit this form online, or you may print & FAX to 912-634-0642, or mail to:
Epworth By The Sea
P. O. Box 20407
St. Simons Island, GA 31522
Please email any questions to: lstrande@epworthbythesea.org

* 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.
This form is for Epworth By The Sea ONLY.

PURCHASE ORDER CREDIT CARD AUTHORIZATION FORM


*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

CREDIT CARDHOLDER INFORMATION

AUTHORIZED USER OF CREDIT CARD:

AUTHORIZATION OF CARD USE