Summer Program Application

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Department Sponsored Program Summer Housing Application

June 9th - August 10th, 2008

MIT Affiliation and Conference Billing Requirements

The Housing Office provides accommodations only to MIT affiliated groups. Housing charges for Conference Groups/Department Programs, must be billed to an MIT Department account number upon completion of the program. Unfortunatley, the housing office is not equipped to collect payments from individual conference guests, that is the responsibility of the program coordinators . If you are in need of additional event managerment services such as registration, fee collection, meeting space, media services, in addition to on campus housing, please contact the Conference Services Department for further assistance.

When requesting an MIT group reservation please complete the following information :

____________________________________________________________________________________________________________________

CONTACT INFORMATION

Organization/Conference Name :
Conference Coordinator :
Address 1 :

City : State : Zip:

Daytime Phone Number : *E-Mail Address :

MIT Sponsoring Department (required)

MIT Sponsor Contact (if different from above)

MIT Account Number (required for conference billing)

Program Emergency After Hours Contact Information:

Primary After Hours Contact

Cell Phone Home Phone

PROGRAM DATES & PARTICIPANT INFORMATION

Arrival Date / / Departure Date / /

Number Of Guests Guest Type

* PLEASE NOTE: All youth groups (participants under 18) must have a 6:1 chaperone ratio. and will be required to complete an additional Youth Program Waiver . Once completed this document may be faxed to the MIT Undergraduate Housing office (617) 258-8163 or sent interoffice to: E19-429..

# of Single Rooms # Of Double Rooms

# of Efficiencies

Building Preference

(Building preferences cannot be guaranteed - building assignments based on availability)

Comments:

I have read and agree that this is only a request for conference housing during summer period of June 9 - August 10, 2008.

Submission of this form does not guarantee that your request will be granted.

Please review this form for correctness, then when finished. Or, click this button to erase your entries and start over.

Reservation confirmations , will be sent via email upon approval.