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 Number (from our confirmation 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: