JUBALHEIRS
Housing Form for Epworth By The Sea
Thursday, October 26, 2023 - Saturday, October 28, 2023

First Name *

Last Name *

Male

Female

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

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

Number of Adults in Room: *

I am paying for how many people? *

My room is being paid for by: *

Special Request (Diet, disability, etc):

Arrival Date: +

Departure Date: Date: +

Rates listed below are per person based on the number of adults staying in the room together, and include lodging for 2 nights and 6 meals, state of Georgia motel fee and taxes. Meals start with Thursday supper and go through Saturday lunch.
PLEASE SELECT FROM THE FOLLOWING ACCOMMODATIONS:

Pitts/Booth Motel:

Single: $335.84

Double: $234.60 per person

Triple: $195.40 per person

Quad: $185.16 per person

Number Children in Room with Adult (age 3-12) - $57.30 per child:

Number of Teens in Room with Adult (age 13-17) - $126.98 per child:

Please include total payment with reservations by October 5, 2023.
Make check payable to Epworth By The Sea.

Check #:

Check Amount:

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

Credit Card Type

Amount To Charge:

CARD NUMBER:
NOTE: IF PAYING BY CHECK PLEASE PUT "N/A" IN THIS SPACE! *

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:
Any individual cancellation after October 5, 2023 will forfeit the first night’s rate.
Any individual cancellation after 72 hours of arrival date will forfeit the entire per person charges. .
Reservations not accepted by phone but may be mailed, faxed, or emailed to the information below.

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:
rlewis@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.
This form is for Epworth By The Sea ONLY.

PLEASE PRINT A COPY FOR YOUR RECORDS BEFORE SUBMITTING

JUBALHEIRSHousing Form for Epworth By The Sea Thursday, October 26, 2023 - Saturday, October 28, 2023

Rates listed below are per person based on the number of adults staying in the room together, and include lodging for 2 nights and 6 meals, state of Georgia motel fee and taxes. Meals start with Thursday supper and go through Saturday lunch.PLEASE SELECT FROM THE FOLLOWING ACCOMMODATIONS:

Please include total payment with reservations by October 5, 2023.Make check payable to Epworth By The Sea.

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

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