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1. GUEST INFORMATION Register online at www.travelennium.com or fax this form to 866-617-9595. HOUSING REQUEST FORM Juice Plus+® LIVE · October 18-20, 2018 · Tampa, FL Travelennium: 800-807-0761 First Name: Last Name: Phone: Address: City: State: Zip: Email: Club Member status at Juice Plus+® LIVE Phoenix 2018 (circle if applicable): 75 100 Club Members will receive priority if submitted by 5/11/18 Hotel confirmation will be sent via email by 6/22/18. 2. ARRIVAL & DEPARTURE DATE Please (X) your arrival and departure day below. 6. RESERVATION AND CANCELLATION POLICY (Only 1 reservation per person) ARRIVE (X) DEPART (X) MON 10/15 TUES 10/16 WED 10/17 THURS 10/18 FRI 10/19 SAT 10/20 SUN 10/21 3. ROOM TYPE Number of beds requested (please circle): 1 2 No preference Disability requiring special services (list requirements): Credit Card Type (circle one): VISA MC AMEX DISCOVER CC #: — — — Exp. Date: / (Expiration date must be valid through 10/2018 5. METHOD OF PAYMENT This card will be used to process any deposit or cancellation fees (see #6 at right for details). Signature: Today's Date: By signing this form, I acknowledge that I have read and agree to the terms listed on this form. I also agree that the credit card provided is valid and I authorize this card to be used for any non-refundable deposits and cancellation fees that are applicable to me, based on the policies stated on this form. SIGNATURE (REQUIRED TO PROCESS) • Travelennium will accept reservations, changes and cancellations from 4/26/18-9/11/18. • (Only effective if entire reservation is cancelled. Does not apply to waitlist and changes.) 4/26/18-7/11/18 = No cancellation fee 7/12/18-8/8/18 = $50 cancellation fee 8/9/18-8/31/18 = $100 cancellation fee 9/1/18-9/11/18 = $200 cancellation fee • Cancellation and change requests prior to 9/11/18 must be made in writing to Travelennium either via email (mgareiss@travelennium. com) or fax (866-617-9595). You will receive a confirmation email that your reservation has been cancelled or changed. If you do not receive this email, it is your responsibility to contact Travelennium. • 9/12/18 = Rooming lists will be submitted to the hotels. A nonrefundable deposit of one night room and tax will be charged by the hotel using the credit card provided on the housing form. • 9/12/18-9/30/18 = NO changes or cancellations allowed as hotels are inputting rooming lists. • 10/1/18 = First date the hotel will accept changes, cancellations or name changes (transfers) to your reservation. New reservations must now be made directly with the hotel and will be accepted on a space available basis at the hotel's prevailing rates. • Cancellations made from 9/12/18 to 72 hours PRIOR to your arrival date will forfeit the non-refundable one night room and tax deposit. • Cancellations made inside of 72 hours of your arrival date will incur an additional charge of one night room and tax (2 nights total). This includes early departures and no shows. • Date Change information: Date changes can be made at any time (based on availability). As long as your date change is at least 72 hours prior to your arrival date, there is no fee. • Transfer information: Your non-refundable deposit will be applied to the transferred reservation. It is your responsibility to collect any deposits from the person to whom you are transferring the reservation. A credit card of the person the room is being transferred to must be given to the hotel to ensure the transfer is complete. This card will be charged for room nights, early departures or no shows. • Prior to any reservation being processed, any outstanding fees or non-refundable deposits from previous conference hotel reservations due to cancellations or declined credit cards must first be paid in full. Reservations are processed in order of receipt and are fulfilled on a space available basis (based on your requested arrival/departure dates and room type). Special Requests: Embassy Suites Aloft Hilton Sheraton Tampa Riverwalk Westin Tampa Waterside Tampa Marriott Waterside 4. HOTEL SELECTION Rank only the hotels you wish to have considered in the processing of your reservation.