| Your Name: |
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| Your member #: |
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| Your Email Address: |
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...and the fields you want to change. Leave the rest blank.
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| Partner's Name, if any: |
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| Your profile (up to 20 words about who you are and what you do): |
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| Address: |
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| City: |
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| State or Province: |
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| Zip/Postal Code: |
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| Country: |
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| Email Address (if you want to change it): |
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| Website: |
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| Daytime Telephone: |
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| Evening Telephone: |
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| Fax Number: |
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| Family Type: |
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| Number of Children at Residence (if any): |
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| Type of Residence: |
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| Handicap Accessibility at Your Residence?: |
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| Children Welcome at Your Residence? |
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| Are there Pets at Your Residence? (check as many as apply): |
None
Not Allowed at this Location
Dogs
Cats
Fish
Other: |
| Smoking allowed at Your Residence?: |
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| Views from Your Residence?: |
or Other:
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| Total number of bedrooms: |
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| Total number of people your home can comfortably sleep: |
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| Total number of bathrooms: |
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| Setting of Home: |
Urban
Suburb
Rural
Coastal
Mountains
Resort
Other
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| Transaction(s) Offered: |
House or Apartment Exchange
Hospitality Exchange
Room Exchange
Room Rental
House or Apartment Rental
Open to all Offers
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| Destinations: |
Open to all Destinations
...or List up to 8 specific countries, cities or states
1.
2.
3.
4.
5.
6.
7.
8.
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| Dates of Travel: |
Open to all Dates
...or Specific Dates (i.e., 25 AUG-8 SEP)
---or Duration in days, weeks or months
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| If giving specific dates and duration, are they: |
Flexible
Firm
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| Household Language Capabilities (select as many as apply): |
Speak:
Read:
Write:
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| Special Situations (choose as many as apply): |
Car Necessary
Exchange autos
Boat available
Bicycle(s) available
Experienced exchanger
Domestic help
Exchange motorcycles
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| In The Community (choose as many as apply): |
AIDS resources
Antiqueing
Bathhouse
Beach (Nude)
Beach (Public)
Coffeehouse
Cultural events
Convenient shopping
College/University
Friendly Neighbors
Forest/Woods
Gay/Lesbian Bookstore
Gay/Lesbian Clubs and Bars
Lake
Mountains
Museums
Ocean/Sea
Quiet Neighborhood
River
Restaurants
Theatre
Public Transportation
Tourist Sightseeing
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| About Your Home (choose as many as apply): |
Air conditioning
Antiques
Barbecue
Balcony/deck
CD Player
Computer
Dishwasher
DVD Player
Elevator
Fax Machine
Fireplace
Garden
Garage/Parking
Gourmet Kitchen
Hot tub/Sauna
Piano
Private Swimming Pool
Public Swimming Pool
Seclusion/privacy
Security/Doorman
Extensive grounds
Television
Tennis Courts
VCR
Washer
Dryer
Waterfront
Yard/Patio
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| Sporting Activities (choose as many as apply): |
Boating
Cycling
Cross-Country Skiing
Downhill Skiing
Fitness Club
Golf
Hiking
Horseback Riding
Spectator Sports
Surfing
Tennis
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| Please write up to 300 words about your home's special charm, location (eg: district in your city, etc), preferred destinations, etc. Very important to help attract potential exchangers! |
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| Privacy Issues (mi casa su casa will never sell, trade, or give your contact information to anyone but other mcsc members via our password-protected listings section. You can also choose not to disclose some information in the Member Directory): |
Do not disclose my phone number(s) on my directory listing
Do not disclose my fax number on my directory listing
Do not disclose my street address on my directory listing - please route all requests through the mcsc office.
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| Desired Password (5-8 numbers and/or letters): |
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| For verification if password is lost, please provide your mother's maiden name: |
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| How did you find out about mi casa su casa? |
Search Engine
Referred by a Friend
Referred by a current MCSC member
Saw banner ad on Out Traveler Site
Saw an advertisement in a book
Responding to a Mi Casa email invitation
Responding to a Purple Roofs email invitation
I am a Previous Member
Other: |
| If you were referred by a current member, please enter their name or member number here: |
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| Any Comments or Questions? |
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| Will you be sending your pictures via email (to mcsc@gayhometrade.com) or via snail mail (to mi casa su casa, PO Box 4714, Walnut Creek, CA 94596)?
Note: if you are a previous member, we may still have your photo(s)
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Sending both via Email
Sending both via Snail Mail
Please check your records and let me know if you have my previous pictures
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| Will you be sending payment via credit card (form on the next page) or mailing payment via check or money order (instructions on next page)? |
Payment Via Credit Card
Payment Via Check/Money Order
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| Do you, the applicant, agree to treat exchange accommodations with extreme care and responsibility? |
Yes
No
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| Verification Code: Sorry for this extra step - this verifies that you are a real person, not an automated piece of software, and helps us weed out spam. Please enter the following text into the field at right:
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