COA ULTIMATE NATINOAL HOTEL REGISTRATION - APRIL 5 - 8, 2012
 
HOTEL REGISTRATION INFORMATION
* If you are paying by check, make ONE check or money order payable to COA, LLC.
* At any time should you cancel a room, you will forfeit your deposit
* A $30 "returned check fee", and the amount of the returned check, may be electronically deducted from your account upon presentation of your returned check from the bank.
* A $50 change fee will be assessed each time you make a change to the original hotel registration form.
* The policy agreement must be signed before your registration will be processed.
* Please fill out the Credit Card Authorization Form in its entirety, you will not be charged the 3% processing fee for your hotel registration.
* Should a refund be made, you will be assessed the $50.00 change fee. Your refund will not be processed until 4 - 6 weeks after the event.
* We will accept a certified check, money order or credit card as forms of payment.

Hotel Cancellation Policy Pricing Schedule
Cancellation Date Percent Refunded*
Prior to
February 1, 2012		 100% Refunded*
February 2 -
March 4, 2012		 25% Refunded*
After March 5, 2012 No Refund
Date Price
Prior to
February 1, 2012		 $225
After
February 2, 2012		 $250
*Less deposits, change fees, and late fees Pricing includes all taxes,
resort fees and parking
POLICY AGREEMENT
I have read COA's rules and policies in their entirety. I understand I am financially responsible for this entire registration. I agree to abide by the rules and policies stated. If my telephone number is placed on the National. Do Not Call Registry, I grant COA, LLC permission to call me at the phone numbers listed herein.


Please Initial Here
CONTACT INFORMATION

Program Name

Contact Person

Home Address

City/State/Zip

Home Phone

Work Phone

Cell Phone

Fax Number

Email address (if email address is provided, confirmation will be sent electronically)


HOTEL INFORMATION
Due to the large number of requests at the COA Ultimate Nationals, hotels cannot
guarantee special requests such as: adjoining rooms, rooms blocked on the same floor
(especially large groups), rollaway beds, cribs, and rooms with views or balconies. Due to
Florida Fire Code and Occupancy Law, rooms with 2 beds cannot accommodate a
rollaway bed and may not house more than 4 people.

Room Type Information:
Quad 4 Names on Room List 2 Beds
Triple 3 Names on Room List 1 bed and twin pull-out
Double 2 Names on Room List 1 bed
Single 1 Name on Room List 1 bed


ROOM BLOCK INFORMATION
  Quad   Triple   Double   Single   Total
Monday, April 2, 2012 + + + =
Tuesday, April 3, 2012 + + + =
Wednesday, April 4, 2012 + + + =
Thursday, April 5, 2012 + + + =
Friday, April 6, 2012 + + + =
Saturday, April 7, 2012 + + + =
Sunday, April 8, 2012 + + + =
Monday, April 9, 2012 + + + =
Tuesday, April 10, 2012 + + + =

Total Rooms
Price $
Hotel Total $

CALCULATE YOUR PAYMENTS
** Full payment is due upon booking

x $225 $ Total Due
CREDIT CARD INFORMATION

Type of credit card to be used

Credit Card #

Expiration Date

CVV Code

Payment to be charged upon request
$

Credit Card Billing Address

Cardholder's Phone Number

Cardholder's Name

Cardholder's Initials**

Date

**By providing your initials, you give COA the right to charge the payment amount upon receipt.
www.coacheeranddance.com 1.800.252.4337