User Information for Invoicing

Please complete this form to report your use of Kemp Station. Thank you!

Name*
First Last
How did you use Kemp Station?*
- Classroom use only, no overnight lodging
- Overnight lodging (with or without classroom use)
Nights of Lodging
Arrival Date Number of People Number of Nights Stayed

Enter the arrival date, the number of people and the number of nights they stayed. If group members stayed different numbers of nights, add additional lines as needed. Example: A group of 10 booked for 2 nights, but one person stayed only one night. You would enter two lines: Line one: MM/DD/YYYY 9 2 Line two: MM/DD/YYYY 1 1
Attendance - Day Use Only
Date Start Time End Time Number of Attendees

Please enter the date and number of people attending your event. If your event was more than one day, please add a second line.
Notes or Comments about your visit
Please provide the email where the invoice should be sent:*
Enter Email Confirm Email
Address of person receiving the invoice:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone number for person receiving the invoice:*
UW-System Funding
If you are paying with UW-System funds, please provide the Cost Center information here so that an Internal Service Delivery can be made.

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Arrival Date	Number of People	Number of Nights Stayed

Date	Start Time	End Time	Number of Attendees