VETERAN TRANSPORTATION AND HOUSING FOR MEETING IN DC

Thank you for participating in the Gulf War meeting. Please help us with arranging transportation and housing accomodations in D.C. by filling in the information below.

* First Name
Joe

* Last Name
Blow

* Street Address
123 anywhere

Address Line 2
-

* City
montgomery

* State
Alabama

* Zip Code
36109

* Phone Number
123-456-0198

* Email Address
jblow@igwc.com

* Cell Phone Number
1-234-567-8910

* Please indicate your travel arrangements with us here

	I have my own transportation
X	I need someone to share travel costs with me
	I need transportation
X	I have my own billeting arrangements
	I need billeting
X	I will eat separately from the group
	I will eat with the group
	I need financial travel assistance
	I do not need financial assistance

* Please indicate the RAC meetings you will be attending

X	September 15-16
	September 24-25

* How many people will be in your party?
1

* How many people will require medical assistance with wheelchairs, scooters, breathing equip., etc. in your party?
1

* Kind of medical equipment needs for you and your party. If you require assistance in walking, please let us know so we can help with getting you where you need to go.
wheelchair and CPAP machine

* Comments - Please utilize this block by giving us your contact information while in D.C. (name of hotel, cell phone number, etc.) so that we have a means of getting in touch with you once everyone arrives.
Allergic to perfumes and most chemicals. Due to diabetes, I require sugar-free meals, so I may buy or take my own meals separate from everyone else. Also, I cannot tolerate standing for long periods of time, so I will require a wheelchair and may need someone to obtain my meals/food for me.

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