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* 1. What is your first name?

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* 2. What is your last name?

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* 3. What is your disability?

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* 4. Please let us know the dates you are interested in overnight housing.

Arrival Date
Departure Date

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* 5. How many people in your party that are in need of housing?

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* 6. How many rooms do you need?

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* 7. Do you have your own transportation to and from the regatta each day?

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* 8. Do you have any service dogs traveling with you?

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* 9. If you are visually impaired, will you have a sighted companion staying with you?

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* 10. Any other information regarding your housing request that you would like us to know?

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* 11. Thank you for answering our questions regarding your housing request.  If you should have any questions, please feel free to contact Paula Fung at lapaula84@aol.com.  

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