Fancy Gap Reservation Request

Please check availability and then complete all relevant information below.

Filling out this form does not guarantee a reservation. You will receive a notification of your request via e-mail.

We will respond within 2 business days to let you know the outcome of your request.

Call x5679 if you have additional questions or needs.

First & Last Name:
University Association:	Reynolda Campus Medical School Emeriti or Retiree
Email:
Phone:
Request Type:	Personal Use Departmental Use
Department:
Departmental Budget Code:
Campus PO Box:
Address
City, State, Zip:

Please Note: Reservations starting dates are only allowed six months in advance. Valid first night requests are November 24th, 2009 until May 24th, 2010
Date of First Night Requested:
Dates of other nights you wish to stay:
Facility Requested:	Lodge (4BR, can sleep 18) Cottage (2BR, can sleep 4) Both

Additional Notes: