Housing Request Form

ACRL is taking care of your room reservation and the billing. We need you to complete the information below so that a room is held under your name.

Name:

Contact Information

Street:

City, State & Postal Code:

Phone:

Fax:

Email:

Meeting:

Occupants (circle no.):  1   2    3   4   5

Arrival & Departure

Arrival Date & Time:

Departure Date:

Type of Room Desired:

___ Single (One person/one bed)

___ Double (Two people/one bed)

___ Double/Twin (Two people/two beds)

___ Triple (Three people/1–2 beds)

___ Quad (Four people/two beds)


Special Requests:

_____ Smoking

_____ Non Smoking