Housing Request Form

First name
Last name
Address
City
Country
Phone number
Fax
E-mail
Occupation
Reason for coming	Work, tourism, study (please indicate your University or place of work)
Number of bedrooms
Number of people
Date of arrival (day-month-year)	January February March April May June July August September October November December
Date of departure (day-month-year)	January February March April May June July August September October November December
Note