2008

Pennsylvania Convnetion

Hotel Reservation Form

Personal Information

Name*

Street Address:*

City:*

State:*

Zipcode:*

Phone:

Email Address:*

Reservation Requst Information

Number of rooms:*

Representing:*

Auxiliary SAL Legion

Arrival Date:*

Departure Date:*

Number of people in room:*

Room Type:

Single King 2 Queen / Double

Room Options:*

Smoking Non-Smoking

Names of others sharing your room:

Guaranteee by Credit Card

Card Type:*

Name On Card:*

Card Number:*

Please enter the month and year of your expiration date below.

Month:*

Year

For your protection, we ask that you enter an extra 3-4 digit number called the CCID. The CCID is NOT your PIN number. It is an extra ID printed on your Visa, MasterCard, Discover, or American Express Card.

Visa, MasterCard, and Discover: On the back of the card in the top-right corner of the signature box. Enter the three-digit number following the credit card number.

American Express: On the front of the card. Enter the four-digit number on the right directly above the credit card number.

CCV*

If you can't read the word, click here.

All characters are case-sensative!

Please enter the characters you see in the image above*: