University of Illinois College of Medicine at Peoria
Reservation Request Form
Visitors, official guests, staff and faculty that are seeking access to UICOMP negotiated rates should use this form. Where applicable, University ID, credit card or authorizing PO may be required at check-in.

Please note this is a request form only, not a confirmation. If space is available, you should receive a notification from the hotel within 24 hours. If you don’t, or if you need to cancel or amend this reservation, please contact the hotel directly.
Required data is indicated by *  
Nature of Booking: *
UICOMP Connection: *
UICOMP Department: *
Purpose of Travel: *
Direct Purchase Requested by: *
   Contact E-mail: *
   Contact Telephone: *
   Contact Fax:
Authorized Travelers *  
   Authorized Traveler 1:
   Authorized Traveler 2:
   Authorized Traveler 3:
   Authorized Traveler 4:
Preferred Hotel:
(Please Select a Particular Hotel)
Please Restate Hotel Here:
(for purposes of emailing):
Traveler Information  
   Arrival Date: *
   Departure Date: *
   Length of Stay - Number of Nights:
   Number of Rooms:
   # of People per Room:
   Smoking/Non Smoking:
   Requested Confirmation Status:
   Room Type:
Event: *

Hotel Services:
   *Check here if this reservation is being paid for by UICOMP.
    If checked, please answer the following:

  

   Yes No Room Nights paid by UICOMP

  
   Yes No Sales Tax waived - For UICOMP Paid Bookings Only  
   Yes No Incidentals paid by traveler  
Form of Payment:
C-FOAPAL Number: (leave blank if not applicable)
Hotel Rewards Program Member Number:
Comments:
Special Requests:
Important Note: Since we are based in Maryland and are not a travel agency, we cannot offer reservations, recommendations or insights to this destination. We are, however, always looking for ways to improve the quality of our Travel Portal.
Please send comments, questions and/or suggestions to:
             larry@campustravel.com