1. Name
2. Address
3. Primary Phone
4. Alternate Phone
5. Email Address

I Can Provide

1. Tent Camping in Yard Yes
   No
2. If Yes, Approximate # of Spaces
3. In House Sleeping Space Yes
   No
4. If Yes, Approximate # of Floor Spaces
5. Riders Need to Bring Bedding Yes
   No
6. Check all that are permitted: Motorhome or Van in My Driveway
   Vehicle in Driveway
   Use of Shower/Toilet Facilities
   Electrical Service Available
   

Additional Services Permitted

1. Check all that are apply: Smoking Permitted on Property
   My Home is SMOKE FREE
   Families with Children Acceptable
   All Male Groups
   All Female Groups
   Mixed Male/Female Groups
   
2. Any other information that would help us in the matching process? (Occupation/Interests)
3. If you have already granted housing to riders/support, list names/contacts