TEAM KIRTLAND HOME AWAY FROM HOME
AIRMEN QUESTIONNAIRE
 
Date Of Birth
Email Address(es):
Emergency Contact Name :
Emergency Contact Phone:
Please check here if your contact information in box is releasable to base staff members.
Your Interests: (please select all that apply)
 
Are You A Smoker: *
Do you use texting via cell phone?
Do you have transportation?

HOST FAMILY REQUEST

Do you prefer a Host Family with more than one Airman?
Do you prefer a Host Family with children under 18?
Do you prefer a Host Family with any of the following?