Junior Optimist Octagon International • 19th Annual Convention • July 5-7, 2011
Housing Reservation Request Form
Baltimore Renaissance Harborplace Hotel • Baltimore, Maryland • Reservation Deadline: June 9, 2011
Reservation requests must be made on this form. Reservations will not be accepted by telephone. Please
complete all information. Mail or fax this form to the address below. Do not mail duplicate copies if faxing this
form. Please send only one form if sharing a room.
Accommodations preferred:
o Single occupancy o Double occupancy o Triple occupancy o Quad occupancy
o Physically impaired accessibility
Contact Person (Chaperone/Advisor/Parent): Please Print
ALL DELEGATES MUST HAVE AN ON-SITE CONTACT AT ALL TIMES!
Name__________________________________________________________________________________________________
Address _______________________________________________________________________________________________
City __________________________ State/Province _____________ Postal/ZIP Code___________ Country__________
Home Telephone Number ________________________________ Business Telephone_____________________________
Fax Number ________________________________ E-mail address _____________________________________________
Arrival Date ________________________________ Departure Date ____________________________________________
Occupants
There will be a $50 cash deposit per person due upon check-in for incidentals if not paying by credit card.
Room 1 Room 2 Room 3
Name____________________________ Name____________________________ Name____________________________
Name____________________________ Name____________________________ Name____________________________
Name____________________________ Name____________________________ Name____________________________
Name____________________________ Name____________________________ Name____________________________
Room 4 Room 5 Room 6
Name____________________________ Name____________________________ Name____________________________
Name____________________________ Name____________________________ Name____________________________
Name____________________________ Name____________________________ Name____________________________
Name____________________________ Name____________________________ Name____________________________
Deposit Information
A major credit card or advance full payment at $149 (inclusive of 15.5% taxes) per night x number of nights is required to
guarantee your reservation and a $50/night deposit will be required at the time of check-in for incidentals.
Card Type ___________________________________ Card Number ________________________________ Exp. Date ____________
Card Holder Name _____________________________________ Signature ________________________________________________
By signing, I authorize my credit card to be charged in compliance with reservations/cancellation policies should I cancel my reservation.
Cancellations
Reservation deadline is June 9, 2011. Reservations received after the deadline will be on a space availability basis. Cancellations can be
made up to 4:00pm on the day of arrival without a fee.
Hotel Use: Date Received ________________________ Date Completed ___________________________ Confirm Fax _____________________