Resident Host Form

Thanks for a Great Time!
Come Back Soon to Enjoy
More of Jefferson's Bells and Whistles!

Jefferson Resident Host Sign Up Form

If you would like to host a RAGBRAI rider (or two or three, etc) fill out and submit the form below.

If you prefer to submit a written form, please download and print out a copy of this form and mail or fax it to our Housing Committee.
Downloadable Host Sign Up Form

If you have any questions regarding becoming a rider host, please use the contact form and select Housing as your subject.
Thanks!



Name*:
Street Address*:
City*:
State*:
Zip*:
Home Phone*:
Work Phone:
Email Address:
	Email is not required but preferred. If it is listed, it will be used for communication.
I can provide:	(check all that apply)
	Tent camping in my yard Approximate # of spaces
	In House sleeping space with Shower/Toilet facilities Give Details Below:
	I have available beds
	# of large bed(s):
	# of twin bed(s):
	I have room for guests utilizing floor space
	# of guest(s) utilizing floor space:
	Motor Home or Van in my driveway I have 30 amp breakers
	Shower/Toilet Facilities
Preferences:	(check all that apply)
	Smoking
	My Home is SMOKE FREE
	(I will allow smoking outside Yes No)
	Family/Children
	(I will allow small children/infants Yes No)
	All Males
	All Females
	Mixed Male/Female
	Any other information that would help us in the matching process (Occupation/Interests, etc)?


	If you have already granted housing to riders/support, please list their names/contacts here:


	* Required Field