ALL REQUESTS MUST BE RECEIVED BY 4PM ON JANUARY 6, 2006
Please read all hotel information before filling out this form.

Name __________________________________________________________________

Sharing with (List all occupants) _____________________________________________

Arrival date (if different for shares) ________________________________________

Address _______________________________________________________________

City __________________________________ State ______ Zip ______________

Phone ____________________ Email ________________________________________

Credit Card # ______________________________ Expiration __________

__ AmEx    __ Visa    __ MasterCard    __ Discover    __ Diners Club

Signature _____________________________________________________________

Arrival Date _____________ Time _____________ (Check-in is after 4PM)

Departure Date _____________ Time _____________ (Check-out is before 12:00 Noon)

Room Type (This is only a request, not a guarantee) '1' for first choice, '2' for second choice:
__ Standard Single - $79    __ Standard Queen - $99    __ Standard King - $119    __ Standard Double - $119  
__ Deluxe King - $139   __ Access King - $139    __ Deluxe Double - $139    __ Junior Queen Suite - $139   
__ Junior King Suite - $139    __ 1-BR Suite - $225    __ 2-BR Suite - $295

__ Request cot (limit 2 per room, no cots in Standard Single or Standard Double)
__ Request crib
If request of Double is not available, please add a cot to my room: __ yes   __ no

Request late checkout: __ 1 pm (free; as available), __ 2 pm ($20 plus tax), __ 4 pm (1/3 normal room rate plus tax),
__ 6 pm (1/2 normal room rate plus tax)

Arisia Block (pick one)
__ Quiet    __ Party    __ Party Host    __ Shabbat    __ Staff
__ Smoking __ Non-Smoking __ No Preference

By requesting a reservation attendee agrees to conditions and limitations listed in Hotel Reservation Policies.