DePauw e-Services: CUR Housing Registration

Council on Undergraduate Research 734 15th St. N.W. Suite 550 Washington D.C. 20005 Fax: 202.783.4811

CUR 2006 National Conference
and Annual Business Meeting
Housing Registration
Business Meeting - June 22-24, 2006
National Conference - June 24-26, 2006

1. Contact Information

Registration Contact Name:

(Last name, First name, Title)
Gender: Male Female

Contact E-mail:

Contact Phone:
(999) 999-9999

Number Attending Requiring Housing:

2. Please list any other people attending requiring housing:

Person 2:

(Last name, First name, Title)
Gender: Male Female

Person 3:

(Last name, First name, Title)
Gender: Male Female

Person 4:

(Last name, First name, Title)
Gender: Male Female

3. Please select the dates that you will be attending:

Date Arrival:

Date Departure:

4. Do you plan to need airport-DePauw or Amtrak-DePauw shuttle service?

Yes No

5. Where would you like to stay?

	Walden Inn ($80 per night) Please Note: Walden Inn rooms are limited. June 24, 2006 and June 25,2006 have no availability. The Walden Inn will bill you for room charges as they accrue. Please provide credit card information to the Walden Inn upon arrival. The housing registration system is unable to provide payment totals for the Walden Inn.
	On-Campus Housing Single Rooms - $16 per person per night (plus tax) Double Rooms - $10 per person per night (plus tax) Special Family Rate - $30 per family per night (plus tax)
	Off-Site Lodging (ex: Days Inn Cloverdale)

6. Subtotal: $

7. Putnam County Innkeeper's Tax: $

8. Indiana State Tax: $

9. Total Amount: $

10. Payment Option

Credit Card (Preferred)
Check
N/A

Name on Card:*
Card Type:*
Card Number:*
Card Expiration Date: * (MMYY)
Card Verification Number: * (3-digit number on the back of your card)

, Quantity:*	x $
Amount:*	$

Billing Address:*
City:*
State:*
Zip:*
Country:*
Phone:* (999) 999-9999
E-mail:*

* - Required Fields