Hotel Reservation Form - Conference on Democratic Performance
Binghamton University, Binghamton, New York
June 7-9, 2001

(Please print and mail this form to the Binghamton Regency Hotel)

Binghamton Regency Hotel and Conference Center
225 Water Street, PO Box 2237, Binghamton, NY 13902-2337
Tel: (607) 722-7575 Toll Free Direct: (800) 723-7676 Fax: (607) 724-7263

Convention Code: 100441
Group Name: Binghamton University, Center on Democratic Performance

Last Name:

First Name:

Arrival Date:

Departure Date:

Address:

City:

State:

Zip:

Telephone:

Government/Tax Exempt:

[  ] Yes

[  ] No

Number of Person Sharing Room:

Room-mate’s Name(s) # :

Special Requests:

[  ] Smoking

[  ] Non-smoking

Name on Credit Card:

Credit Card #:

Expiration Date:

Signature*:

Date:

* By signing above, I acknowledge that I have read and understand the terms of my reservation as indicated on this form, and authorize the Binghamton Regency Hotel to process total room and tax charges to the credit card indicated above.

# Use second page for room-mate information and submit all pages together.

• Reservations are accepted on this form only. Please do not call and book a room as well.

• Please fill out only one form per person. Please indicate if sharing a room, and send room-mate’s reservation form together. A confirmation will be mailed to you.

• Rates will be charged on the number of guests registered to the room.

• Cots must be reserved in advance at an additional charge of $15.
  Tax exempt certificate and government ID must be submitted with payment or add 11% tax to the above rates.

• Each individual must present their own NYS tax exempt certificate and government ID along with this reservation form or individual will be charged inclusive package rates.

• Check in time is 4:00 pm; check out time is 12:00 pm.

• Room types and special requests are on an availability basis only (smoking/non-smoking).

• Form must be received by Thursday, May 17, 2001 along with full payment. Please note that personal checks are not an acceptable form of payment upon check-in, but are acceptable up to ten days prior to arrival. Only cash or credit cards are acceptable upon check-in.

• Cancellation must be made by Thursday, May 31, 2001 in order to receive a refund.

Hotel Reservation Form

(Continuing Page – Room-mate Information)

Number of Person Sharing Room:

(Please use one form per person and submit this with your roommate’s reservation)

Last Name:

Arrival Date:

Address:

City:

State:

Zip:

Telephone:

Government/Tax Exempt:

[  ] Yes

[  ] No

Special Requests:

[  ] As above

Name on Credit Card:

Credit Card #:

Expiration Date:

Signature*:

Date: