2012 SRAM TOUR OF THE GILA
Host Housing Request Form
* - Required Field

*Contact Name: (Last Name) (First Name)
*Gender Male Female      *Racing Category Select One Men Pro 1 Women Pro,1,2 Men 1,2 Men 3 Master Men A Men 4 Master Men B Women 3,4 Staff

*Team:

*Street Address:

*City: *State: *Zip Code: *Country

*Home Phone: *Email:

*Expected Arrival: *Expected Departure:

Names, etc. of additional racers or staff for whom you are requesting housing:

Are there any couples in your group? Yes No If yes, how many couples?

Please give the name(s) of any racer or staff having any special concerns or considerations such as allergies, etc. and specify the concern:

Payment method

Instructions for paying via PayPal or Cedit/Debit Card

The following page will have a link to PayPal. Remember the fee is $10 per person from this form, your request will be delayed if you do not submit the correct amount.

Instructions for paying via Check

The following page will have Mailing information to complete your payment. Note on your check the "Contact Name" from this request.

PLEASE NOTE: Housing is given on a first come-first served basis. Paid registration and housing fees are required before your request will be placed on the list in the order in which it was received. You will receive host contact information by email, or by phone. Remember there is a nonrefundable $10.00 per person charge for placement on the housing list.