Information Form

Group Name*:
First and Last Name*:  
Street Address*:
(2-25 characters)  
(US/Canada Only)  
ZIP/Postal Code*
Email Address*
Daytime Phone* - -
Phone Country Code:  (If outside US/Canada)   
Evening Phone - -
Phone Country Code:  (If outside US/Canada)  
Fax - -
Phone Country Code:  (If outside US/Canada)  
Meeting Dates*:
Number of attendees:*:

Number of guest rooms*:                 
Meal Functions*
(select all that apply)  
If "Yes" select options below
Do you have Audio Visual Needs?*
Additional Requirements*:
* denotes required field

The Brossman Center
7301 Germantown Avenue
Philadelphia, PA 19119

(215) 248-7339 or (866) 548-7339

We would like to hear from you!

Please feel free to eMail us at with any questions or for more information on rates and availability. You can also submit information using the form below.

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