2015 SUMMER SPONSORED SHORT-TERM HOUSING RESERVATION FORM TO RESERVE ACCOMMODATIONS, PLEASE DO ONE OF THE FOLLOWING—Conference Services does not take reservations by phone. Please do not email the form containing credit card information. • MAIL the completed housing reservation form with payment to: P. O. Box 400734, Charlottesville, VA 22904-4734. • HAND DELIVER the completed housing reservation form with payment to the Conference Services office between the hours of 8AM to 5PM, Monday through Friday. • Full Payment must accompany your reservation form in order for it to be processed. RESERVATION DEADLINES 30 DAYS PRIOR TO ARRIVAL DATE. ALL FORMS MUST BE RECEIVED BY 5:00 PM ON THE DEADLINE TO AVOID A LATE FEE. • • LATE RESERVATION FEE: A late reservation fee of $50.00 will be assessed to all forms received after the above deadline. We cannot guarantee requests for accommodations submitted after the deadline; however, we will make every effort to meet your request. CANCELLATION POLICY: If Conference Services receives written notice of cancellation at least seven days prior to your scheduled arrival date, you will receive a refund less a $50.00 cancellation fee. Student residents will be charged $50.00 plus one-week’s (7-days) stay in housing for cancellation requests received less than one week (7 days) before the scheduled arrival date. This includes requests made after check-in. Personal Information (FILL OUT THIS FORM COMPLETELY. PLEASE TYPE OR WRITE LEGIBLY IN BLUE OR BLACK INK.) Name: ________________________________ Local Address: City, State, and Zip Gender: M F Student ID #: ________________________ ___________________________________________________________________________________________ E-mail Address: ________________________ Local Phone #: _________________ Permanent Phone #: _______________ Permanent Address: City, State, and Zip ______________________________________________________________________________________ Handicapped-accessible accommodations required? Y Are you a UVA student? Y Roommate request: N N If Yes, please explain on a separate sheet. Check One: ¨ Undergraduate ¨ Graduate ¨ High School ¨ Other _____________________________________________________________ All roommate requests must be mutual and designated as such on both/all reservation forms in order to be honored. Roommates share an apartment but all bedrooms are single occupancy. Affiliated Group: McIntire Business Institute (MBI) Arrival and Departure Information • • • • • There is a Two-Night minimum stay required for all reservations. The earliest possible arrival date is Wednesday, May 20, 2015. The latest possible departure date is Friday, July 31, 2015. Check-in is after 2:00 PM on all other scheduled arrival dates. Check-in location will be communicated by e-mail via your registration confirmation. All students must vacate their housing by 11:00 am on the day indicated on your reservation form. Keys must be returned to the Conference Services office in Page House. The latest possible departure time is 11:00am on Friday, July 31, 2015. You MUST return your keys & vacate your room before the designated time to avoid additional charges. Charges & Payments Charges are based on the number of NIGHTS, charged at $40.00 per night. A late fee of $50.00 must be applied to all reservations received by Conference Services after the deadline. Checks (made payable to the University of Virginia) are processed immediately. Dates of stay: / / 15 to / / 15 Total number of nights: Cost per night: Housing charges: Late reservation fee, if applicable: TOTAL AMOUNT DUE: X $34.00 $ $50.00 $ Circle Payment Method: Check Credit Card Credit Card Number: Expiration Date: By providing my signature, I attest that I have read and understand all of the information above. Signature: ______________________________ Date: PO Box 400734, Charlottesville, VA 22904-4734 Web: www.uvaconferenceservices.com Phone: (434) 924-4479 _____________