Reservation Request Form
*=required field
Name first*
middle initial
 last*
 
Gender * male female
Address street address *
 
     

city *

state

country *
zip (or postal code for non US addresses)
 *
Telephone
area code *
phone number *
   
   
Fax
area code
phone number
   
Email*
Are you attending a conference or program? *
YES NO
Please enter the name of the conference that you are attending
 Please type in your reason for visiting or your UC Berkeley affiliation

Arrival date *

, 2009

   
Arrival time * (reservations are held until 6pm unless a later time indicated)
   
Departure date * , 2009 (check out time is 12:00 noon)
   
Room Selection *
(please check one)		 Single Room $61.00 per night
Number of Single Rooms Requested 		Double Room $61.00 per night
Number of Double Rooms Requested
RoomMate Name(s) Please separate multiple names with commas