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Short-term Stay Reservation
First Name:
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Last Name:
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Phone Number
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Email Address:
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Confirm Email Address:
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Check-in Date:
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Check-out Date:
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Reason for stay?
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Athletics
Campus Tour
Gear-Up
Nursing Clinicals
Theater
Other
Other
Please list any additional information below:
Each room costs $30 per night (plus tax). This amount is non-refundable. The total must be paid to the Western Business Office before arriving. Please call 307-382-1613 to pay.
Please provide your signature below:
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By submitting this form, you declare under the penalty of perjury that the information furnished is, to the best of your knowledge and belief, true, correct, and complete. If you have questions, call the Dean of Students Office at 307-382-1888.