Billet Registration

Please fill out all fields indicated by the * and click Become a Billet to submit your registration.

First Name:*

Last Name:*

Address:*

Apt#:

PO Box:

City/Town:*

Postal Code:*_{(Without Space)}

Date of Birth:(yyyy-mm-dd)*

Home Phone:*

Work Phone:

Cell Phone:

Home Email:

Work Email:

Billet Home Information

Do you have any pets?*	YesNo
Smoke free?*	YesNo
Provide reliable transportation?*	YesNo

Willing to prepare breakfast for students with special diets?*	YesNo
Home is wheelchair accessible?*	YesNo
A resident of the home speaks French?*	YesNo
Billet Preferences
Gender*	Male Female No Preference
Number of billets?*
In an emergency could you billet more?* If Yes How many? (Including number above)
Requests