THE RIVERHOUSE

3075 N Highway 97

Bend, OR 97701

541-389-3111 hotel 541-389-0870 fax

800-547-3928 reservations

Pre-Reg Registration Form

Name: ___________________________________________________________________________

E-Mail Address: ___________________________

Home Address (optional): ___________________________________________________________

City, State & Zip: __________________________________________________________________

Telephone: _______________________________________________________________________

Name of Company/Employer: _______________________________________________________

Address: _________________________________________________________________________

City, State & Zip: __________________________________________________________________

Telephone: _______________________________________________________________________

Credit Card Name & Number: ___________________________________ Exp Date: _________

I authorize the Riverhouse to charge this card for all charges not cleared at check out time.

Signature: ______________________________________________________

How many times per year will you be staying at the Riverhouse? _____________________________

Room Type Requested: _____________________ Rate for this room: _______________________

Prefer upper or lower floor? _________________ Smoking or Non Smoking? _________________

Other requests? ____________________________________________________________________

Applicant’s Signature: _________________________________ Date: ______________________

(Please mail or fax this form to the above address or fax number)

_________________________________________________________________________________

Riverhouse Use Only

Approved and Authorized By: _____________________________ Date: _____________________