Lodge Reservation Payment Form

Please print this page, fill out the form and mail it along with your payment to:

Dave Clark
1924 Hoag Rd.,
Warners, NY 13164

Contact Person:   Evening Phone:
Arrival Date:   Departure Date:
Member Information
Member 1   Member 2
Name:   Name:
Preferred Lodging: Private Room
Ladies Dorm
Men's Dorm
  Preferred Lodging: Private Room
Ladies Dorm
Men's Dorm
Member 3   Member 4
Name:   Name:
Preferred Lodging: Private Room
Ladies Dorm
Men's Dorm
  Preferred Lodging: Private Room
Ladies Dorm
Men's Dorm
Reservation Restrictions:
  • Any cancellations must be received before reserved dates, if not, a $5.00 charge will be assessed.
  • All reservation credits from cancellations must be used in the current membership year or they will be forfeited.