Central States - Convention Housing October 12-13, 2012 Deadline to submit hotel registration is , 2012, show all persons names occupying room.
PLEASE NOTE: NO PHONE ORDERS WILL BE ACCEPTED If you have NOT received a confirmation from Bill within 4 days please contact him.
Address A value is required. City A value is required. State A value is required. Zip A value is required.
Email A value is required. Arrival Date and Time A value is required. Departure Date A value is required.
** SPECIAL NOTE: If only one name is listed on tis form, you will automatically be assigned a single bed room. Please list all names staying in the room.
1. Name A value is required. A value is required.
2. Name
3. Name
4. Name
Room rates listed DO NOT include taxes.
If you require special needs for housing please indicate here
NOTE: Hotels require a credit card to make a room reservation or a check for the first night room rate, or the hotel will not accept the reservation. Prices listed DO NOT include State or City taxes. The hotels WILL NOT accept reservations from individuals or groups.
Room Reservation by credit card : Type of Card Expiration date
Card Number
PLEASE NOTE: PHONE ORDERS WILL NOT BE ACCEPTED! Submit housing form to :
Bill Phelps 1402 15th Street Belle Plaine, IA 52208 319-430-2414
phelps.family@mchsi.com
I have already submitted the registration forms to the CSD registrar
IF YOU DO NOT RECIEVE AN ACKNOWLEDGEMENT THAT BILL HAS RECEIVED YOUR REGISTRATION WITHIN 4 DAYS, PLEASE CALL IMMEDIATELY