Training Lodging Request Form

2. Lodging arrangements are available on a limited basis for Kansas residents traveling 60 miles or more to attend this training.

   Participants from organizations that have access to federal preparedness grants or funding should make lodging or reimbursement arrangements with their agency/organization. 

   Submitting this form does not guarantee that the participant will receive lodging arrangements. Participants will receive an acknowledgement email from our office to confirm eligibility; and an second email with lodging confirmation (if eligible) with rooming information.

4. Name*
5. Email Address*
7. Agency/Organization*
9. Address*
11. City*
12. State*
13. Zip Code*
15. Phone Number*
17. Course/Event Name Attending:*
19. Course/Event City:*
20. Course/Event Date(s):*
    Course/Event Date(s): Start Date

    —

    Course/Event Date(s): End Date
22. By requesting lodging arrangements provided by KDEM I am agreeing to the following terms:
24. 1. To be eligible for lodging arrangements from KDEM I must be a Kansas resident, traveling 60 miles or more from my home to attend the training mentioned above. By signing I also confirm that I am not a Federal or private employee.
26. 2. KDEM/Adjutant General’s Department makes Direct Bill agreements with available hotels in the area and as a participant I am not necessarily able to pick which hotel I want to stay in.
28. 3. I have mobility issues and request special accommodations as follows (e.g. need first floor room, wheelchair access): *

    1. No

    1. Yes
30. 4. Approximately one week from the class/event mentioned above, I will receive an email with hotel information and registration confirmation.

    a.    Check-in date is the day before class/event (after 3pm) and check-out should be the morning of the last day of class. 

    b.    I will be required to request a receipt from the front desk and will give it to instructors or the last day of class.

32. 5. I understand that the hotel will ask for a credit card to keep on file in case of incidentals.
34. 6. I understand that KDEM will be responsible only for my room charge, they will not pay for any room service, meals or additional fees from the hotel.

    a.    I will be responsible for extra smoking charges or damages to my room. 

    b.    Some hotels offer free continental breakfast, I agree to make sure no meals, or additional charges appear in my hotel bill. 

36. 7. CANCELLATIONS: Should I need to withdraw from class within 48 hours before my check-in time, I agree to call the hotel and cancel my registration first.

    a.    I will also contact the KDEM Training Office, or call (785) 646-2407 to notify them of my absence. 

    b.    I can also withdraw my class registration from KS-TRAIN at www.train.org/ks. 

    c.    I understand that should I fail to cancel my room reservation, I (and/or my agency) will be responsible for any “No Show” charges incurred by KDEM. 

38. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree with statements above.

    The State Training Office normally send out lodging confirmations a week before the course/event. 

    1. I agree.
40. Electronic Signature
Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit Submit and Print

* indicates a required field