Memory Lane Inn - Frequent Stay Guest Form

Our Frequent Stay Program allows you to stay for free after every 5th visit! Once you've made a reservation, simply fill out this form and supply us with your guest list. Whenever a guest has stayed with us 5 times, their next stay will automatically be comped. This form should only be filled out once per reservation, preferrably by the person making the reservation.

Stays are counted by email address - therefore if your email address has changed between stays, let us know and we will update your previous visits with your new email address.

Your Reservation Confirmation Number (from email):

Guest #1 ("Hostess")

First Name:

Last Name:

Email Address:

Guest #2

First Name:

Last Name:

Email Address:

Guest #3

First Name:

Last Name:

Email Address:

Guest #4

First Name:

Last Name:

Email Address:

Guest #5

First Name:

Last Name:

Email Address:

Guest #6

First Name:

Last Name:

Email Address:

Guest #7

First Name:

Last Name:

Email Address:

Guest #8

First Name:

Last Name:

Email Address:

Guest #9

First Name:

Last Name:

Email Address:

Guest #10

First Name:

Last Name:

Email Address:

Guest #11

First Name:

Last Name:

Email Address:

Guest #12

First Name:

Last Name:

Email Address: