Name:

Address: Postal Code:

Home Phone: Work Phone: Cell Phone:

E-mail:

Description of space available:
i.e. Single bed in spare bedroom and shared bathroom with family

Number of people who live at your residence:
Males: Females: Children:

Do you have pets in your home? Yes: No:
If yes, what kind:

Do you smoke in your home? Yes: No:

Will you permit smoking?
Indoors - Yes: No: Outdoors - Yes: No:

Will you provide parking?
On property - Yes: No: On street - Yes: No:

Would you prefer to billet:
Males: Females: Couples: Children: No preference:

Please indicate the total number of people you can accommodate:

What bus routes service your area?

What is the best way & time for your guests to contact you when they arrive?

Additional information that would enable us to match you with a compatible performer: