Apply for Local Housing – Orange City welcomes RAGBRAI

Name(Required)

First Last

RAGBRAI Confirmation Number(Required)

RAGBRAI Wristband Number

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Mobile Phone

Work Phone

Email(Required)

Club/Team Name

Total Number in Group

Number of Males in Group

Number of Females in Group

Number of Children in Group

Number of Vehicles

Club/Team Member Names

First Name

Last Name

Confirmation No.

Wristband No.

Age

Occupation

Specify up to 20 members. If you have more, please contact us directly.

Housing Amenities Desired (check all that apply)

Tent Camping in a yard

Motor home or Van in driveway

Shower/Toilet Facilities

Smoking

Pets

Non-Smoking

In House sleeping space

Allow Children

Tent Spaces Needed

Number of People for Floor Space

Interests

Other Important Information

Payment to help defray costs

Price:

Total to be paid at this time

Credit Card Payment(Required)

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

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Orange City Chamber of Commerce