Official Housing Request     CUT-OFF DATE IS JULY 14, 2014
Housing Chairman: Mrs. Mary Jo Jaska, 254-744-6838     mjcjaska@att.net
 

If you are updating a previously completed registration, please put that registration number here: 

Your Information
First name:  Last name:  
Title:
Jurisdiction:
Address:
City:  State/Province:  Zipcode:
Country:
Home Phone:  Cell Phone:
Email:
Chapter:
 

Hotel Selection Note - Prices are per night. Tax not included. COMFORT INN will charge $10 per extra person for more than 2 in room.
1st Choice:  Hilton and Courtyard by Marriott are sold out.
2nd Choice:  Hilton and Courtyard by Marriott are sold out.
Room Information   Note - Rooms with 2 beds have queen beds.
Room Type:      Number of Occupants:  
 
Arrival Date: Departure Date:  
 

Name and Title of All Occupants (2013-2014 Grand Chapter Year)
Name:      Title:  
Name:      Title:  
Name:      Title:  
Name:      Title:  
 

Credit Card Information
Name on Card:      Credit Card Type:  
Credit Card Number:      Expiration Date:     
Credit Card Billing Zipcode:        Credit Card Security Code:  3 Digits for MC/Visa/Discover, 4 Digits for Amex
 

 
Comments/Special Needs:
 

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