Fairport Harbor Historical Society

Paranormal Group Facility Request / 2010

* Date Requested:  ___________________ * Arrival Date/Time: -7:45 pm 

*  Request Received By: ______________   * Departure Date/Time:- Midnight  

*  Date Received: ____________________ *  Contact Name:  ______________ 

* Group Name:  _____________________ *  Tour Leader Name: __________ 

* Address: ____________________________  *  Deposit: $100.00                                                          

          ________________________________                    (nonrefundable) 

* Phone  Number: Cell/Home (circle ) __________________________________        

CHARGES

DESCRIPTION OF CHARGES	# of Persons	Amount Charged
Group  Rate -$300.00	10  max
Paid by Check/# _______   Cash ______
Total of all charges

NOTES