NAME_________________________________________________________________________

ADDRESS______________________________________________________________________

CITY_____________________STATE/ZIP__________________PHONE____________________

                            PLEASE LIST THE NAMES OF THE PEOPLE IN YOUR ROOM:

1.____________________   3.____________________ 5. ____________________

2.____________________   4.____________________ 6. ____________________

___I have attached my deposit made payable to The Shadrix Trio ($25.00 per person)

___I have provided credit card payment for the $25 deposit per person to secure my room

CREDIT CARD INFORMATION: ___VISA ___MASTERCARD ___AMEX

NAME AS IT APPEARS ON CARD__________________________________________________

CARD NUMBER_________________________________________EXP DATE_______________

CARDHOLDER SIGNATURE_______________________________________________________

HOST- SHADRIX TRIO

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PLEASE PRINT THIS FORM OUT, COMPLETE IT AND RETURN WITH DEPOSIT TO:
SHADRIX TRIO, LLC
PO BOX 242
WHITESBURG, GA 30185
P: 770-854-6363 F: 770-854-3017