E-mail Address:
*
My interest
*
Rent Bedroom at Center
Rent a RV or 5th Wheel at Center
Have my own RV
Have my own 5th Wheel
Have my ownTravel Trailer
Other
If you marked other above, please explain
When will you be available to join us
*
Why that particular date?
*
If you are furnishing your own Rig does it have
Working Shower?
Working Heating?
Working Toilet?
# of people over 16 of age, the second person is required to attend all Workshops in addition to the 21 Barter-Hours
*
Prefix
*
Mr
Miss
Mrs
Ms
Dr
Primary Person
*
What states have you lived during the last 10 years
*
Birth Date
*
1
2
3
4
5
6
7
8
9
10
11
12
/
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
/
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
Do you have any physical limitations with
*
Back
Legs
Arms
Emotional\Mental Problem
Have no Limitations
Other
If you marked Other please explain
What are your skills
*
Construction
Web Design
Carpenter
Writing Articles & Blog
Plumbing
Electrical
Solar
Landscaping
EMT
Medical
Animal Care
Gardening
Have you ever been convicted of a felony?
*
Yes
No
Do you give your permission for a background ckeck?
*
Yes
No
Second Person Prefix
Mr.
Miss
Mrs
MS
Dr
Second Person Name
What states have you lived during the last 10 years
Birth Date
1
2
3
4
5
6
7
8
9
10
11
12
/
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
/
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
Do you have any physical limitations with
Back
Legs
Arms
Emotional\Mental Problems
Have no Physical Limitations
Other
If you marked Other please explain
Have you ever been convicted of a felony?
Yes
No
Do you give your permission for a background ckeck?
Yes
No
What are your skills
Construction
Carpenter
Web Design
Plumbing
Writing Article & Blog
Heating
Electrical
Animal Care
Solar
Medical
Gardening
Landscaping
# of Children
Name of Oldest
Oldest Child Date of Birth____________________________________________
1
2
3
4
5
6
7
8
9
10
11
12
/
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
/
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
Do you have a Pet? If so, what is it name and describe
*
Relationships
*
Married
Single
Partner
Divorced
How long have you been at this status
*
Less than one year
Between 1 and 5 years
Between 5 and 20+ years
All my life
Type of vehicle will you be driving?
*
Truck
4 WD Truck
Car
No Vehicle
Other
What is causing you to apply for this lifestyle
*
I want to have a free place to stay
Would you like to learn more about
*
Gardening
Chickens
Ducks
Goats
Cow
Horse
Other
The Temperature on the Oregon is nearly always between 40 – 70 degrees and it is cloudy and rains a lot. Why do you want to want to leave where you are for this lifestyle?
*
I like cool weather
Do you have source of money for
*
Food
Fuel
Propane
Medical Care
Personal Items
Other
What is the source of your money?
*
Social Security
Retirement Income
Unemployment
Food Stamp
Have to get a local job
SSI
Saving
Other
Do you
Need Internet
Owe a Gun
Want to Fish
Use Illegal Substances
Name of Emergency Contact that will not be living with you
*
Relationship
*
Phone Number
*
Employer or some who can comment on your working habits
*
Position
*
Their Phone Number
*
Your Current Phone Number
*
Your Current Address
*
Your Current City
*
Your Current State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington, DC
West Virginia
Wisconsin
Wyoming
--U.S. Territories--
American Samoa
Federated States of Micronesia
Guam
Midway Islands
Puerto Rico
U.S. Virgin Islands
Your Current Zip Code
*
Verification Code:
Enter Verification Code:
*
*
Required