You may use the following form to email your request to the Housing Bureau, note that this is an insecure form which offers no security protection. If you do not wish to send your Credit Card information via email, please print this form and fax or send via postal service. 


First Choice:     
Second Choice:    
Third Choice:     
Indicate Type of Room Requested:
			 
Any special requirements? Wheelchair accessible, etc. 
			 

Please Describe:   
Arrival Date:     
Arrival Time:      
Departure Date:   

Guarantee to:	  
Credit Card Number:      
Experiation:      

Name of Occupants(s) [Bracket names sharing rooms]
                  
Person to whom confirmation should be mailed:
Name:             
Affiliation:      
Address:          
City, State/Province:    
Postal Code:      
Country:          
Telephone Number: 
Fax Number:

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