Pittsburg State University
55th Annual Coaches Clinic


June 20-21 * Lamplighter Inn (formerly Parkview Inn) * Pittsburg

RESERVATION REQUEST

Lamplighter Inn
4020 Parkview Drive
Pittsburg, Kan. 66762
(620) 231-8700 * Fax:(620) 230-0154

Name:_____________________________________________________

Address:__________________________________________________

City, State, Zip:_________________________________________

Phone (H):______________________(W):______________________

I desire the following accommodations from:

____/_____/____ to ____/_____/____

O 2 double beds @ $51 (rate guaranteed thru June 1)

O 1 king bed @ $51 (rate guaranteed thru June 1)

Credit Card Name:_________________________________________

Credit Card Number:_______________________________________

Credit Card Exp. Date:____________________________________

Card Holder’s Signature:__________________________________

I understand this reservation will be held for me until 6 p.m. on the day of arrival shown above.

Written Confirmation Requested    O Yes   O No