Lodge Reservation Payment Form

* For your convenience, we have designed this form so that you can type your information into it and then print the completed 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.