For those of you who may require Community Housing while staying in the DC Metro area, please print out this form, or just write out ALL of the required information if you don't have a printer, and send it to the National Office at: 1012 14th STREET, NW, SUITE 705 WASHINGTON, DC 20005 ATTN: COMMUNITY HOUSING PLEASE BE ADVISED that submitting this form DOES NOT guarantee we will be able to give you Community Housing. We strongly urge you to continue to search for hotel or other lodging space. Should you submit this form and later find your own lodging space, please contact us so we can remove you from our Housing database. 1993 MARCH ON WASHINGTON FOR LESBIAN, GAY & BI EQUAL RIGHTS AND LIBERATION REQUEST FORM For Community Housing during the week of the March. TODAY'S DATE: NAME: STREET ADDRESS: CITY/ST/ZIP: DAY PHONE #, with area code: EVENING PHONE #, with area code: WHICH NIGHTS WILL YOU REQUIRE HOUSING? (circle all that apply): WED, 4/21 THURS, 4/22 FRI, 4/23 SAT, 4/24 SUN, 4/25 MON, 4/26 TUES, 4/27 WED, 4/28 Other:________ Will you be bringing children? YES NO Please list the names of all persons accompanying you. Include children's ages: DO YOU SMOKE? YES NO ARE YOU ALLERGIC TO ANIMALS? NO YES (list): WILL YOU BE BRINGING A CAR? YES NO PLEASE LIST ANY SPECIAL NEEDS, SUCH AS ACCESSIBLE SPACE: ARE YOU OFFICIALLY REGISTERED WITH THE MARCH? YES NO YOU WOULD PREFER TO BE HOUSED WITH (circle all that apply): MEN WOMEN EITHER GAY ANYONE LESBIAN BISEXUAL TRANSGENDER NON-GAY SUPPORTER We will try our best to accommodate March participants, but CANNOT guarantee perfect settings or matches. Please include any other information which you think will assist us in meeting you housing needs.