First Name

Last Name

Email

Phone

Street Address

City

State

ZIP Code

Optional Discount Code (see above)
click to apply code

If you stayed in the last 30 days, who made your last reservation? (to verify your discount)

Names of guests redeeming their free stay reward
(Please verify each guest has at least 5 eligible stays on their account first. We will apply the discount to your balance once approved.)
Characters remaining:

How Did You Hear About Us?
-- Select -- Prior Visit Friend Scrapmania Facebook TripAdvisor.com Personal Scrapbook Convention Search Engine Drive By Other

Additional Comments
Comments only! Questions should be sent to jereme@memorylaneinn.com instead
Characters remaining: