Austin, TX Conference
The Roommate Form

 

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Leave this field empty

Please click on the appropriate circle or supply the appropriate text:

What is your gender?
Male Female

What is your smoking preference for a roommate?
Non-smoker Smoker No preference

What night do you want to start sharing a room?
Saturday night (6/13)
Sunday night (6/14)
I'm flexible about my arrival night

What day do you plan to checkout?
Wednesday (6/17)
Thursday (6/18)
I'm flexible about my checkout day

With how many roomies do you prefer to share a room?
only one other person
more than one other person would be better for my travel budget
I'm flexible about the number of other persons I have as roommates

Please enter your name here:

Please enter your email address here:

Please enter your phone number here in the format nnn-nnn-nnnn:

Your additional comments -- do you already have a room reserved? at which hotel?
what would the cost be to share this room with you?:


If you need to contact the human who maintains this form, she is:
Amy Van Epps
vanepa@purdue.edu