SHORT TERM Temporary HOUSING Request for RESEARCH and RESEARCH SUPPORT STAFF REGISTRATION Lindcove Research and Extension Center 22963 Carson Ave Lindcove, CA 93221
Shelby Motley Phone: (559) 978-7864 Email: smotley@ucanr.edu	Jasmin Del Toro Phone: (559) 592-2408 x1151 Email: jzdeltoro@ucanr.edu
Arrival Date: Departure Date: Number of Guests: Name: Telephone: Address: City: State: Zip: Country: Email Address: Researcher or Sponsor: UC Affiliation and Purpose for the visit: Enter a short description of the purpose of your visit. License Plate #: Make: Model: Does anyone staying in the room require special emergency evacuation becasue of a disability? Yes No PAYMENT PROCESS Payments are due ON or BEFORE arrival date. The housing fee is due on the 1st of each month. Current Research Project rate per person / per night - $30.00 Current Research Project rate per person / per month - $600.00 Cleaning Deposit - $75.00 (balance refunded after cleaning fees deducted if needed) Payments may be made by any of the following methods: 1. Paid by check. Make checks payable to UC Regents 3. Recharged to a UC account (fill out section below) UCD Account Number: -- UCB Account Number: -- ---- UCR Account Number: -- --- - Dept Accounting Contact:
UC assumes no responsibility for loss of money, jewels, other valuables or contents left in room or auto. I agree that my liability for this bill is not waived and agree to be held personally liable in the event that the indicated person, company or association fails to pay for any part or the full amount of these charges. We are a non-smoking and alcohol-free facility. No drinking is allowed on the facility. Smoking in any guest room will result in a fine of $100.00 which will be applied to your bill. AGREEMENT TO TIMELY VACATE: By signing this document, you agree to vacate the premises by the departure date and time noted above. You understand that should you not vacate the guest room by the agreed date and time, UC will enter the guest room, re-key the door to the guest room, and make the guest room available to a new guest. In that event, UC will also take possession of your property which will be returned to you. (Civil Code § 1865). Initials NO CHANGES TO TERMS OF STAY: Extension of your stay and/or acceptance of any amount past the check-out time referenced above does not alter the terms and conditions of your stay. The stay remains transient and a new term is not created. The acceptance of any amount due by UC after the check-out day and time referenced above shall not be construed as a waiver by UC of its rights to remove you from possession of the premises. Initials PROOF OF ELIGIBILITY: UC ANR is a public entity that provides on-campus lodging for visiting scholars, guest speakers, attending a meeting, lecture/class, or conference sponsored or hosted by UC ANR. The maximum length of stay is 29 consecutive days and a maximum of three people per room is allowed. Upon request by UC, you will provide proof of eligibility to be staying on UC property. Failure to do so will accelerate your departure date to the next day.
A confirmation will be sent within 2 business days. Please contact us if you do not receive one. By typing my name below, I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature.