Copy and paste this information into your word processor, or print it from your browser.

When you're done, click here to return to the Boulder Front Page Mensa home page.

HOST REGISTRATION FORM

Name:

Address:

City, State, Zip:

Home Telephone:

Work Telephone:

Email:

Mensa Group/Region:

Mensa Membership Number:

Occupation:

Languages Spoken:

Interests & Hobbies:

Nearby Centres of Interest:

Nearby Public Transportation:

Do you:

q       Smoke

q       Have pets in the home

q       Have children

What kind of hospitality can you offer?

q       Information on travel

q       Mensa activity

q       Sightseeing guidance

q       Accommodation for _________ persons for _________ days maximum

q       Impromptu Mensa open house

q       Meals

q       Transportation

q       Telephone/Email hospitality & advice only

Are you bothered by:

q       Smoke

q       Pets

q       Children

Is some form of payment requested?

q       Accommodation

q       Meals

q       Transportation

Please include any additional comments that may help us to better select guests for you:

Dated 

Signed