birchstreet form

Reservations
Please use this form to reserve your room
(The form below can also be printed and faxed to 1-867-633-5625)
Reservations maybe secured with a deposit of 40% of expected total-
to a minimum of one night's lodging.

Name:

Address1:

Address2:

City and Postal Code:

Country:

Email Address:

Phone:

Fax:

Number in Party:

Arrival Date:

Departure Date:

How will you be travelling:

Arrival Information -
flight number, time and
airline or bus company:

Do you have any special needs?
diet, wheelchair access etc...
please explain:

Name:
Address1:
Address2:
City and Postal Code:
Country:
Email Address:
Phone:
Fax:
Number in Party:
Arrival Date:
Departure Date:
How will you be travelling:
Arrival Information - flight number, time and airline or bus company:
Do you have any special needs? diet, wheelchair access etc... please explain: