0929e Family and Friends Lodging and Meals, National Veterans

OMB Number: 2900-0759
Expiration Date: Xxx, 20XX
Respondent Burden: 35 Minutes

FAMILY AND FRIENDS LODGING AND MEALS
NATIONAL VETERANS CREATIVE ARTS FESTIVAL
DEADLINE:
PRIVACY ACT: VA is asking you to provide the information on this form under USC, Chapter 5, Section 521 and Chapter 17, Section 1710. VA may
disclose the information that you put on this form as permitted by law. VA may make a "routine use" disclosure of the information as outlined in the
Privacy Act systems of records notices identified as 121VA19 “National Patient Databases - VA”. Providing the requested information is voluntary.
However, you will not be able to participate in the event without furnishing this information.
RESPONDENT BURDEN: The Paperwork Reduction Act of 1995 requires us to notify you that this information collection is in accordance with the
clearance requirements of Section 3507 of the Paperwork Reduction Act of 1995. We may not conduct or sponsor, and you are not required to respond to,
a collection of information unless it displays a valid OMB number. We anticipate that the time expended by all individuals who must complete this
application will average 35 minutes. This includes the time it will take to read instructions, gather the necessary facts and fill out the forms.

All Festival participants, support staff, and volunteers will be staying at the
Rooms will be available at this hotel for family and friends of Festival participants. If you wish to stay at the
you must fill out this form, include payment, and return it to the
by
.
INFORMATION ON FAMILY MEMBER/FRIEND (Please print all information)
NAME (Last, First, MI)

TELEPHONE NUMBER 1
(Include area code)

TELEPHONE NUMBER 2
(Include area code)

FAMILY/FRIEND OF A:

ADDRESS (Street, City, State and Zip Code)

RELATIONSHIP TO VETERAN/
STAFF/OTHER (Specify, i.e. spouse,
caregiver, sister, friend, etc.)

VETERAN PARTICIPANT

STAFF MEMBER

OTHER

Air Transportation Information

AIR ARRIVAL INFORMATION
DATE

TIME

DATE

TIME

AIRLINE

FLIGHT NUMBER

AIR DEPARTURE INFORMATION
AIRLINE

IF ROOMING WITH A PARTICIPANT, PLEASE CHECK ONE
ROOM WITH ONE KING BED @ $

PER NIGHT

FLIGHT NUMBER

PARTICIPANTS NAME:
ROOM WITH TWO QUEEN BEDS @ $

PER NIGHT

IF NOT ROOMING WITH A PARTICIPANT, PLEASE CHECK BELOW
ROOM WITH ONE KING BED @ $

PER NIGHT

ROOM WITH TWO QUEEN BEDS @ $

PER NIGHT

NOTE: Performers will arrive on Monday, 10/21 and artists will arrive on Wednesday, 10/23. Everyone will depart on Monday, 10/28.
PLEASE CHECK THE NIGHTS YOU ARE PLANNING TO STAY

VA FORM
FEB 2014

0929e

.
,

Lodging Payment
The Festival organizing committee will make your lodging reservation for the dates you have indicated on the previous page.
I intend to pay for my lodging costs via credit card and will present my credit card to the hotel upon check-in.
Please include my name on the Festival master lodging list. I understand that my room will be reserved for the dates that I have indicated
on the previous page, that I will receive the special Festival lodging rate, and I will not need to contact the hotel to make my reservation.
The Grand Sierra Hotel has an early check-out fee of $50, except in the case of illness or and emergency situation. There is a $200 fine for
smoking in a non-smoking sleeping room.
Meal Plans
Meal plans will be purchased upon arrival. In order to determine counts for each meal, we ask that you indicate on this form what meals
you intend to purchase. You will pay for meal plans during main registration on Monday, October 21 or Wednesday, October 23. If you
arrive after that date, please go to the Festival Headquarters Room at the Grand Sierra Hotel to purchase meals.
Checks will be made payable to: Grand Sierra Resort-Meals
The Grand Sierra Resort is unable to accept credit cards as a form of payment for meals.
**When plated (not buffet) meals are served, my preference is:
***When dessert is served, I prefer a sugar-free dessert.

YES

MEAT

VEGETARIAN

NO

Indicate below what meal plan you will purchase upon arrival.
I wish to purchase (Select only one meal plan among options A, B, or C.)
PLAN A $

(7 Dinners, 5 lunches, and 7 breakfasts) Includes Dinner on Sunday, 10/27.

PLAN B $

(5 Dinners, 3 lunches, and 5 breakfasts) Includes Dinner on Sunday, 10/27.

PLAN C $

(3 Dinners, 1 lunch, and 3 breakfasts) Includes Dinner on Sunday, 10/27.

Please submit the completed Family & Friends Lodging & Meals form by

Stephanie Torian
Host Site Coordinator (05/Vol)
VA Sierra Nevada Health Care System
975 Kirman Avenue
Reno, NV 89502
Phone: (775) 328-1411 / Fax: (775) 337-2276
[email protected]

VA FORM 0929e, FEB 2014, page 2

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