PCOS Advocacy Day 2020 - Roommate Request Form

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PCOS Advocacy Day - March 11-12, 2020

If you would like to share a hotel room or Airbnb with a fellow PCOS Advocacy Day attendee during the event, complete this form and PCOS Challenge will try to find you a match.

Please Complete the Form Below

First Name *

Last Name *

Organization (If applicable)

If you are participating as part of an organization or professional society, please list your affiliation.

Gender *

Female

Male

CONTACT INFORMATION

Email Address *

Phone *

Facebook Username

I give PCOS Challenge permission to share the following contact information with potential matches (check all that apply): *

My Email Address

My Telephone Number

My Facebook Username

Required

ADDRESS

Please list your address below and we will also contact you if a lodging travel grant becomes available for advocates from your Congressional district.

Address *

Suite/Apartment/Unit

City *

State or U.S. Territory *

Zip Code *

TRAVEL INFORMATION

Travel and Accommodations information may be found on the PCOS Advocacy Day website at https://pcoschallenge.org/pcos-advocacy-day/travel/.

Already have a room? *

Yes

If you already have a room, what is the name and address of the hotel or Airbnb?

Departure Date *

YYYY

Arrival Date *

YYYY

ADDITIONAL COMMENTS

Notes

Submit

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