SLAC Reservation Request


SLAC Guest House Request for a Reservation For Medical Center Affiliated Individuals

ARRIVAL/DEPARTURE INFORMATION

Enter the date in the format MM/DD/YYYY.

Date of Arrival
Date of Departure


HOUSING OPTION
All rooms are non-smoking only.
Daily Rates
One full sized bed	$71 + 10% occupancy tax (Standard room)
One queen sized bed	$87 +10% occupancy tax (Larger room)
Two full sized beds	$103 +10% occupancy tax (Larger room)
One set of twin bunk beds	$ 87 +10% occupancy tax (Larger room)

Roommate: (Please enter name of roommate, if any.)

Standard room:	Larger room:


GENERAL INFORMATION

Name*
	Last	First
Mailing Address*

	City	State/Province
	Zip/Postal Code	Country
Daytime Phone*
E-mail*
FAX
Department
* Required fields


ELIGIBILITY INFORMATION

Please select your affiliation from the list below.

If Other, please specify:


REASON FOR VISIT
Please specify your reason for this visit (required) and any additional comments.


CONFIRMATION
After you submit this form, you will receive an email confirmation to confirm your request for a reservation at the SLAC Guest House. Please do not submit this form more than once.

Return to the SLAC Guest House Reservations page