Hello Guests.
To help respond to your requests quickly, please email us at:
[email protected]
1. We will need the attached credit card authorization form completed
by the name of the person staying in the room.
2. You may also state “PLEASE CALL” on the subject line of your
email and our staff will call you. 3. Please include in the email:
a. Booking ID: 1999
b. Bed preference e.g., king or 2 doubles
c. Dates you are reserving
Thank You!
One Time Credit Card Payment Authorization Form
Sign and complete this form to authorize Twin Arrows Navajo Casino Resort to make a onetime charge to your credit card listed below.
By signing this form you give us permission to charge your account for the amount indicated
on or after the indicated date. This is permission for a single transaction only, and does not
provide authorization for any additional unrelated debits or credits to your account.
Please complete the information below:
I ____________________________ authorize the Resort to charge my credit card
(full name)
account indicated below for _____________ on or after ___________________. This payment is for
(amount)
(date)
_____________________________________.
(description of goods/services)
Billing Address ____________________________
Phone# ________________________
City, State, Zip ____________________________
Email ________________________
Account Type:
Visa
MasterCard
AMEX
Discover
Cardholder Name _________________________________________________
Account Number
_____________________________________________
Expiration Date
____________
CVV2 (3 digit number on back of Visa/MC, 4 digits on front of AMEX) ______
SIGNATURE
DATE
I authorize the above named business to charge the credit card indicated in this authorization form according to the terms outlined
above. This payment authorization is for the goods/services described above, for the amount indicated above only, and is valid for
one time use only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card
company; so long as the transaction corresponds to the terms indicated on this form.
Native Innovation 2015 Education Technology Conference
“Release Your Digital Innovator”
June 12-13, 2015
Twin Arrows Navajo Casino Resort
Flagstaff, Arizona
Conference Registration Form: Please fill out legibly
Name of School or Organization:
POC (Point of Contact):
Address:
City: ___________________ State:
Phone:
Zip:
Fax:
Email:
Conference Registration Fee: All Paid Participants will receive a Chromebook
Registration (*Chromebook Included)
$399 Per Person
Group of 5 or more (*Chromebooks Included) $250 Savings
$349 Per Person
Group of 10 or more (*Chromebooks Included) $740 Savings (Best Deal)
$325 Per Person
Vendor Fee Only (Fee includes 2 people, 1-table and 2-chairs)
$300 Per Vendor
NAME / Title
E-Mail Address
AMOUNT
Method of Payment: Must be attached to registration.
Check #__________
Purchase Order #________
TOTAL: $_________
We#do#accept#all#major#credit#cards.#Please#visit#www.nativeinnovation.com#to#process#CC#payments.##
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Cancellation#Policy:#Non$refundable-$250-per-person.-Cancellation-request-can-be-emailed-and-must-be-receivedby-May-31,-2015,-no-exceptions.-Substitutions-are-accepted.-Please-fax-(877.511.2342)-or-mail-completedregistration-form-with-payment-or-Purchase-Order-to:-Native#Innovation#Inc,#1750#S.#Railroad#Spring#Blvd#Ste#9,#
Flagstaff,#Arizona#86001#
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