Name:Phone#:N#
Hotel Choice: The Liberal Inn The Gateway Inn Holiday Inn Express BlueBird Inn Bed and Breakfast Super 8 Best Western
Credit Card: Mastercard Visa Discover American Express # Exp:
If you do not want to provide your credit card information on-line, you may print this form and fax it to 620-624-0566.
Arrival Date:ETA:
Departure Date:
Number of Rooms 1 2 3 4 5 6 7 Number of Nights: 1 2 3 4 5 6 7 Smoking Preference: Non-Smoking Smoking
Bed Size: Whatever Available No Preference King Queen Twin Single Number of People: 1 2 3 4 5 6 7 8 9 10 Shuttle: Yes No
Additional Information:
