HOTEL RESERVATION FORM WORKSHEET (DO NOT SUBMIT THIS FORM. THIS IS FOR YOUR CONVENIENCE ONLY WHEN YOU RESERVE YOUR ROOM ONLINE) ONLINE) CALIFORNIA TEACHERS ASSOCIATION IRVINE MARRIOTT April 25 25 – 27, 2014 2014 TYPE OF ACCOMMODATION: (CHECK ONE) One room request per reservation form. Should additional forms be needed, please photocopy. The hotel must receive reservation requests no later than: ** FRIDAY, MARCH 28, 2014 ** Single Occupancy (1 King Bed) $120.15* Double Occupancy (2 Queen Beds) $120.15* *On a space and rate availability basis, the hotel room rate above includes applicable taxes and fees (parking NOT included). Self-parking is $12.00 per day/night. Valet parking is $23.00 per day/night. Please see additional stipulations on the back of this page. Arrival Date/Time Departure Date ~ CHECK-IN: 4:00 PM ▪ CHECK-OUT: 12:00 NOON ~ SPECIAL REQUESTS: Wheelchair accessible room RESERVATION FOR (please print or type): Other: First Name Last Name Association/Chapter Note: There is no guarantee of room type, although the hotel will do everything possible to accommodate your request. HOTEL RESERVATION DEPOSIT INFORMATION: All reservations must be guaranteed with credit card for first night’s lodging. Address (Street, City, Zip) Phone Fax FORM OF PAYMENT: Email Address for confirmation American Express Diner’s Club Discover MasterCard Visa SHARE WITH: First Name Last Name First Name Last Name Name as it appears on Credit Card Credit Card Number First Name Last Name Page 1 of 2 Expiration Hotel Reservation Cancellation Policy Cancellations must be made at least 24 hours prior to arrival date. Cancellations made in less than 24 hours prior to arrival date will be charged an amount equal to one night’s deposit to the credit card. Late Check-out penalty fee: Late check-outs past 1:00PM are subject to a late check-out charge and based upon availability. After 6:00PM, full daily room rate will be charged. Page 2 of 2