World Balloon Convention 2012 Roommate Request Form
Please fill out the form below to request a roommate for the WBC 2012 at the Dallas Sheraton Hotel. Your information will be processed and forwarded to a WBC representative, who will contact you regarding possible roommate options. Please be sure to enter information in all the requested fields for fastest response. Once we’ve processed your request and you receive a response, please proceed in contacting your roommate(s) to clarify who will be booking the hotel room and to discuss payment arrangements.

* Required Fields

*	First Name:
*	Last Name:
	Company Name:
*	Address 1:
	Address 2:
*	City:
*	State/Region/Province:
*	ZIP/Postal Code:
*	Country:
*	Phone Number :
	Alternate Phone Number:
*	E-mail Address:
*	Arrival Date: (MM/DD/YY)
*	Departure Date: (MM/DD/YY)
*	How many TOTAL people would you prefer in your room (including yourself)?	2 3 4
*	Smoking or Non-smoking:	Smoking Non-smoking
*	What languages do you speak?
	NOTE: By submitting the WBC Roommate Referral form, you automatically consent to having your name, phone number, and e-mail address shared with others for the purpose of locating a WBC 2012 roommate. Submit this Form