EPWORTH BY THE SEA
GA Addiction Counselors Association
April 2 - 5, 2017
A SECURED PAGE FOR EPWORTH BY THE SEA
Your Name  
Address  
City  
State       Zip Code    
Phone         Email    
*Room Registration is per person per night and includes meals beginning with supper on day of arrival and goes through lunch on day of departure and all taxes.
View Accommodations at: epworthbythesea.org/accommodations
Please check applicable rate:
LODGING
SINGLE
OCCUPANCY
DOUBLE
OCCUPANCY
TRIPLE
OCCUPANCY
QUAD
OCCUPANCY
TURNER LODGE
$162.66
$111.19
per person
$93.96
per person
$85.52
per person
ROBERTSON INN
$151.19
$102.82
per person
$83.64
per person
$79.78
per person
PITTS/BOOTH
$140.51
$95.94
per person
$77.90
per person
$75.19
per person
Child Rate in room with adult ages 3-12 years: $19.02 per night.
Teen Rate in room with Adult: $43.71 per night
Roommates Name:
Special Request   (Disability, diet, etc.)
Arrival Date Departure Date
Number of Adults in room:   Number of Children in room:   Number of Teens in room:
I am paying for: how many adults?        how many children?        how many teens?   
My room is being paid for by:
PLEASE INCLUDE TOTAL PAYMENT WITH RESERVATIONS.
Make check payable to Epworth By The Sea.
Check #    Amount: $   
OR
Charge to:    Visa      MasterCard       Discover      Amount to Charge: $
Card Number:        Expiration Date:
Name on Card:       
 Check here to affirm that I am authorized to make these credit card charges
Epworth Cancellation Policy:
Full payment due with reservation by March 18, 2017.
Any cancellation after March 24, 2017 will result in forfeiture of $20.00 per person. 
Any cancellation within 72 hours of arrival will result in forfeiture of entire per person charge.
Please submit this form online, print & FAX to 912-634-0642, or mail to:
Epworth By The Sea
ATTN: Lori Strande
P. O. Box 20407
St. Simons Island, GA 31522
No phone reservations accepted. No pets or alcohol. Check in: 4:00 p.m. - Check out 11:30 a.m.
* CONFIRMATION OF YOUR RESERVATION WILL BE SENT TO YOU *
This form is for Epworth By The Sea ONLY.