American Society of Dowsers On Campus Lodging and Meals Guest Registration Form
LYNDON STATE COLLEGE
One form per person please
Name: ______________________________________________________________ Male/Female
Mailing address: ________________________________________________________________________
City and State: _______________________________________________________Zip Code___________
Phone: ______________________________ Email: __________________________________________
In case of emergency contact: ________________________________phone:________________________
Desired Roommate: ________________________________________________________________
Male/Female
** IF DESIRED ROOMMATE IS NOT REGISTERED BY THE MAY 13,
2005 DEADLINE, THE COLLEGE RESERVES THE RIGHT TO ASSIGN A ROOMMATE
TO YOU.**
Special Housing Needs: ____________________________________________________________________________________
*** PLEASE INDICATE NEED & REASON SINCE 1ST FLOOR
AND SINGLE ROOMS ARE VERY LIMITED AND FIRST COME/FIRST
SERVE!!***
ALL SUMMER RESIDENCE HALLS ARE NON SMOKING!!!
NO PETS are allowed on campus or in the
residence halls.
Package Plans --- per person cost (includes
meals,lodging and linen)
**** LINEN FEES ARE INCLUDED IN THE PACKAGE PLANS****
DBL = Double S = Single
Package A: DBL: ______ $265.25
S:_____ $314.25
Sunday Lodging (6/12) thru Saturday Lodging (6/18)
with Monday Breakfast thru Sunday Lunch. (Sunday check-in after
4:00 p.m. )
Package B: DBL: ______ $247.25
S: _____ $289.25
Monday Lodging (6/13) thru Saturday Lodging (6/18) with
Monday Breakfast thru Sunday Lunch
Package C DBL: ______ $237.00
S:_____ $279.00
Monday Lodging (6/13) thru Saturday Lodging (6/18) with
Monday Dinner thru Sunday Lunch
Package D DBL: ______
$160.00 S:_____ $188.00
Wednesday Lodging (6/15) thru Saturday Lodging (6/18)
with Wednesday Dinner thru Sunday Lunch
Package E DBL: ______ $83.00
S: _____ $97.00
Friday Lodging (6/17) thru Saturday Lodging (6/18) with
Friday Dinner thru Sunday Lunch
Individual Plans ---- per person costs
*** LINEN FEES ARE NOT INCLUDED*** ($6.00 fee
one time fee)
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($25.00 per person per night single) PLUS $6.00 ONE TIME LINEN FEE Sunday - Check in AFTER 4:00 P.M. |
license plate # ____________________ |
| Sunday (6/12 _______________ | Sunday (6/12 _______________ |
| Monday (6/13) ______________ | Monday (6/13) ______________ |
| Tuesday (6/14) ______________ | Tuesday (6/14) ______________ |
| Wednesday (6/15) ____________ | Wednesday (6/15) ____________ |
| Thursday (6/16) ______________ | Thursday (6/16) ______________ |
| Friday (6/17) ________________ | Friday (6/17) ________________ |
| Saturday (6/18) ______________ | Saturday (6/18) ______________ |
| Sunday (6/19) ________________ | Sunday (6/19) _______________ |
| Monday (6/20) _______________ | Monday (6/20) ______________ |
| $6.00 linen fee: _______________ | ------------------------------------ |
| TOTALS: ______________ | TOTALS: _____________ |
MEALS WITH MEAL COST
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TOTAL OF PACKAGE PLAN $____________________
ADDITIONAL MEALS/LODGING WITH PACKAGE PLAN $____________________
TOTAL OF INDIVIDUAL PLAN $____________________
TOTAL AMOUNT DUE TO COLLEGE $ ___________________
Please make checks or money orders payable to: Lyndon State
College.
For Credit Card Customers (circle card): VISA
MASTERCARD DISCOVER
# _____________________________ Exp. Date: __________ “V” code _____Signature:_________________________
CANCELLATION POLICY
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ASD Conference: Attn-Wheeler Lyndon State College PO Box 919 Lyndonville, Vermont 05851-0919 Phone: (802) 626-6267 Fax: (802) 626-4817 |