Juneteenth Overnight Stay Request

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Event Timing: June 18, 2023 1 p.m. - June 19, 2023 9 p.m.
Event Address: 123 Your Street Your City, ST 12345
Contact us: (207) 387- 1932 or info@thethirdplace.me

This signup for is for individuals in the BIPOC community who would like to request an overnight stay on FORTLAND from June 18th - June 19th. Accommodations will be provided in Fortland's tents and yurts. However, there are a limited number of spots available. If you would rather pitch your own tent in a location of your choosing, this will increase our capacity to host more people overnight.

Submitting this request does not guarantee you an overnight stay. You will be contacted by June 3, 2023 if you will be gifted an overnight stay. Please note that there is a $50 REFUNDABLE deposit for all overnight stays.

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First and Last Name *

Pronouns

Email Address *

Cell Phone Number *

City of Residence *

Are you any of the following (check all that apply): *

Board Member (for Third Place)

Sector Organizer (for The Third Place)

Identify as Black, Indigenous, or Person of Color AND Employed at a BIPOC-led Organization

Participate in a SHIFTMaine networking group (ECO-BIPOC, Media & Communications, Banking & Financial Services, etc.)

A Third Place Volunteer

Identify as Black, Indigenous, or Person of Color AND Volunteer at a BIPOC-led Organization

Άλλο:

Name of School or Employer *

Each person may bring one guest. Will you be attending with a guest? Your guest must be your significant other, a family member, or another individual from the BIPOC. *

Yes

If you will be attending with a guest, please provide their first and last name and their relation to you. All correspondence will be provided to you.

What sleeping arrangements are you comfortable with (Check all that apply): *

I want to be in one of Fortland's tents/yurts by myself (Note: This is low possibility.)

I want only want to share accommodations with someone of the same gender

I only want to share accommodations with my guest

I am comfortable sharing accommodations with anyone

I prefer to just secure my own spot and pitch my own tent

Άλλο:

If demand exceeds capacity, are you willing to stay in your own tent or one provided for you? *

Yes, I have my own tent and gear

Yes, However I need a tent and gear

No, I would rather not come

Please indicate your diet below *

None

Vegetarian

Vegan

Kosher Only

Gluten-free

Zabiha Halal Only

Άλλο:

I understand that there is a $50 refundable deposit for my stay in order to secure my spot. This deposit will be returned to me within two days following my stay. If I do not show up for my gifted stay, I will forfeit this deposit.

Enter your name below to indicate that you understand this agreement and confirm that you identify as Black, Indigenous, or Person of Color. Requests without a name entered below will not be considered for a stay.

Comments: *

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