Department Sponsored Program Summer Housing Application

Summer 2010

CONTACT INFORMATION

Organization/Conference Name :
Conference Coordinator :
Address 1 :

City : State :

Daytime

MIT Sponsoring Department (required)

MIT Sponsor Contact (if different from above)

MIT Account Number (required for conference billing)

Program Emergency After Hours Contact Information:

Primary After Hours Contact

Cell Phone Home Phone

PROGRAM DATES & PARTICIPANT INFORMATION

Arrival Date / / Departure Date / /  

Number Of Guests

* PLEASE NOTE: All approved youth groups (participants under 18) must have a 6:1 youth to chaperone ratio and will be required to complete an additional Youth Program Waiver


# of Single Rooms # of Double Rooms

# of Efficiencies

Building Preference

(Building preferences cannot be guaranteed - building assignments based on availability)