Instructions: Print out and fax or mail. (Please print clearly)
Last Name: ____________________ First: ______________________
Address: __________________________________ Apt No. _______
City: ________________________ State: __________ Zip: __________
Home Phone: ( ) _________________Business Phone: ( ) ______________
E-Mail: _____________________________ Age: ______
Additional Guest Name (with package): _____________________________
Referred by: _________________________________________
Package prices are per person double occupancy and include room, entertainment, and parties:
Package #1 ________ Package #2 ________ Package #3 ________ Package #4 ___________
Package #_____ Single bed ______ Double Bed:
Guest (3)_______________________________ Guest (4)____________________________
Please fax order page to reserve your room package. Payment must be received 7
days after order or room package will be released.
Send registration form and payment information (Cashiers Check, Personal Check or Money Order, ) to: PIPS
P.O. Box 451582
LOS ANGELES, CA 90045
or FAX: 310-601-7380
Payment Method:
Grand Total $_____________Total Deposit $____________Balance Due: ________
A deposit of half the total is now due to ensure your space.
Remainder of balance due by June 1, 2012
Consumer Agreement: I understand and agree that any such cancellations do not affect the non-refundability of any deposit or of any package payment that I remit to PIPS Entertainment with this payment. Pips Entertainment will not be responsible for registrations that are not filled out thoroughly.
Signature: _________________________________________________
