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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