LAST NAME: FIRST NAME:

EMAIL: HOME PHONE:

WORK PHONE: CELL PHONE:

I would like to share a room with   ONE (1) TWO (2) or MORE roommates*

* "Family" rooms can accommodate up to 6 people.

I am looking for a   MALE   FEMALE  roommate

I prefer a   NON-SMOKING   SMOKING  room

The dates I need a roommate are: From (first night) through (last night)

Comments:

Contact Mary Lee at marylee@ccvn.com if you have questions.