What is your name?

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* 1. What is your name?

What is your home address?

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* 2. What is your home address?

Will anyone else (or dog)  need to be housed with you?

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* 3. Will anyone else (or dog)  need to be housed with you?

What is your disability?

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* 4. What is your disability?

When do you plan on arriving and departing?

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* 5. When do you plan on arriving and departing?

Do you have transportation to get to and from the regatta from the housing location?

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* 6. Do you have transportation to get to and from the regatta from the housing location?

Please let us know if there is any other information or special needs that you would like to provide regarding your housing request.

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* 7. Please let us know if there is any other information or special needs that you would like to provide regarding your housing request.

Please provide a cell phone number so your host can reach you. Thank you!

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* 8. Please provide a cell phone number so your host can reach you. Thank you!

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