Name of Organization:
Type of Organization:
Contact Name:
E-mail Address:
Mailing Address:
City/Town:
Province/State:
Postal/Zip Code:
Telephone (Day):
Telephone (Evening):
Where we want to stay:
Coastal Inn Silverwood
Fredericton, New Brunswick
Coastal Inn Champlain
Moncton, New Brunswick
Coastal Inn Sackville
Sackville, New Brunswick
Coastal Inn Antigonish
Antigonish, Nova Scotia
Coastal Inn Kingfisher
Digby, Nova Scotia
Coastal Inn Concorde
Halifax, Nova Scotia
Arrival Date:
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Number of Rooms per Night with One Bed:
Number of Rooms per Night with Two Beds:
Number of People in Group:
Special Needs:
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