Name_____________________________________________________________________
Street Address___________________________________________________________
City, State Zip_________________________________________________________
Telephone______________________________ Fax______________________________
Affiliation: GLIIFCA Rates 1-3 personsArrival Date:_______________________ $69.00/night
Departure Date:_____________________ Number in Party:_________
Accommodation:.................................Status:
_____1. King Bed........................____ 6pm Release
_____2. Full Beds.......................____ Guaranteed
Credit Card Type: Amex/visa/Master - Number:_______________________________________exp:___/___
Date:_____/_____/1996
Submit a copy of this application form to the Hotel at:
Hotel St. Regis Registration