On Campus Housing Registration Form

July 19-23, 2017 | Luther College Campus | Decorah, Iowa

PRINT FULL NAME(S) for badges


Telephone Number

Email Address

Street Address

City & State

Zip Code

Emergency Contact  (name, phone, email, relationship)


Special Requests (if you want to share a townhouse/room with a friend who will register separately, list names here.  If you need handicap accessible lodging, etc.)




Does anyone in your party require residence hall  beds to be de-bunked  __ Yes          __ No

Nights staying on campus:  Wed 7/19 [  ]   Thurs 7/20 [  ]   Fri 7/21  [  ]   Sat 7/22  [  ]   Sun 7/23 [  ]

Note: Luther College does not carry insurance on personal property of its summer guests and is not responsible
for loss or damage to such property.

Farwell Hall Single room request  $45/person/night
     traditional dorm housing

$45 X  ____ person(s)

X ___ nights  =

$ ________

Farwell Hall Double room request  $45/person/night

      traditional dorm housing

$45 X  ____ person(s)

X ___ nights  =

$ ________

Baker Village Single room request  $45/person/night

      townhouse-style, limited availability

        $45 X  ____ person(s)

X ___ nights  =

$ ________

Baker Village Double room request $45/person/night

      townhouse-style, limited availability

$45 X  ____ person(s)

X ___ nights  =

 $ ________

 

 

Total

 

$ ________

No later than July 5, 2017, mail this form with your check payable to Telelaget of America to:
Telelaget of America
Judy Mathison
S47W23365 Lawnsdale Rd
Waukesha WI 53189-7907

NO refunds after July 5, 2017