PAYMENT CARD AUTHORIZATIONROBIN WALKER

Email: rwalker@mgmresorts.comFax: 702-597-7087

TRANSACTION INFORMATION:Select Property(s):Aria ◊ - Bellagio ◊ - Circus Circus ◊ - Excalibur ◊ - Luxor ◊ - Mandalay Bay ◊ - MGM Grand ◊

Mirage ◊ - Monte Carlo ◊ - New York, New York ◊ - THE Hotel ◊ - Signature @ MGM ◊ - Vdara ◊

Group/Company Name:

Dates:

Block Code or Account #:

Please select all charges that apply:

Signing Deposit $__________________ Catering $______________________

Contractual Deposit $__________________ Business Center $______________________

Full Prepayment $__________________ Phone Charges $______________________

Guar 1st Ngt $__________________ Audio Visual $______________________

Room & Tax $_______________ Exhibitor Service $______________________

Incidentals $__________________ Resort Fee $ ______________________

Food & Bev $__________________ Other: $______________________Total:

An additional deposit and/or full prepayment of all services may be required.

Approved By: Date:

PAYMENT CARD VERIFICATION:AUTHORIZATION NOTE: I authorize and acknowledge that all of the charges below will be processed to my payment card as

detailed above. I understand that an additional amount might be authorized for incidentals or other related charges. (If using a Debit Card , please be advised that this authorization may affect your checking account until final settlement of transaction). Payment

Card Industry regulations prohibit merchants from requiring or making copies of your card.

o American Express o Discover o MasterCard o VISA o Diners Club

*Last four digits of credit card number:

*Cardholder's Full Name: *Cardholder's Signature:*Cardholder's Billing Address: *City: *State: *Postal Code:*Telephone Number: Fax Number: E-mail Address:

*FULL PAYMENT CARD NUMBER: *EXPIRATION DATE:

* REQUIRED FIELDS

Send to:

Should additional charges be incurred after the final one-hundred percent deposit is received, hotel will charge the credit card and provide a statement following the group departure.

______________________________________________________________ ______________

Credit Card payments will be accepted based on the terms and conditions negotiated in the contractual agreement between the parties and confirmed in writing by signature approval of this form.

CREDIT CARD AUTHORIZATION FORM Soccer Team/ Club Name:

Team Hotel: Excalibur $56 (Q/Q Thu/Sat Rate) + $18.00 (Resort Fee) x 12% (Tax) = $82.88 Total / Night$86 (Q/Q Friday Rate) + $18.00 (Resort Fee) x 12% (Tax) = $116.00 Total Per Night

1) The difference between the Stay for Play Minimum Room Night Requirement of 30 rooms (10 Rooms with a 3 night minimum) and the Teams final room nights paid at the Team Hotel at the Rate/Night (pre tax/applicable resort fee).

2) 1st Nights stay or full reservation amount at the Team Hotel (determined by hotels cancellation policy through the Tournaments contract with the Hotel) at the Rate/Night (pre tax/applicable resort fee) for any cancellations or no shows outside of the Tournament Cancellation timeframe.

Cardholder Name (please print):

Cardholder Billing Address:

City: State: Zip Code:

Phone Number: Email:

Type of Card: □ VISA □ MASTERCARD □ AMERICAN EXPRESS □ DISCOVER

Card Number: Exp. Date (mm/yy): Security Code*:

*The non – embossed 3 digits printed on the signature panel on the back of your card immediately following the cardnumber. The American Express security code is the non – embossed 4 digits printed on the front of the card.

Notify cardholder of the full amount to be charged the card listed above prior to processing payment

Yes (Select Method) Email Phone Decline Notification By checking the box, I acknowledge that I am the responsible party for the Soccer Team /Club listed above and for the

teams Tournament hotel reservations. I will also inform the team and players of the process and deadlines for any changes, no shows or cancellations at the Teams Hotel. Changes and Cancellations MUST be submitted in writing to info@soccertournamentconcierge.com on or before Friday, October 21, 2016 to avoid any penalties or non –participation in the Tournament.

By checking the box, I authorize Las Vegas Thanksgiving Classic (c/o Eventure, LLC, DBA Sports Tournament Concierge) to charge the credit or debit card provided on this credit card authorization form the amount authorized above.

Cardholder Signature: Date:

E-Mail form to info@soccertournamentconcierge.com or call (702) 202-2107 with any questions.

$30 (Q/Q Sun-Wed Rate) + $18.00 (Resort Fee) x 12% (Tax) = $116.00 Total Per Night