Please Note:

Camp Roller Disco may be filling up -- we won't really know how many people we can accommodate until Burning Man tells us our camp's location and size. So if you are reading this message and applying to join our camp for the first time please note that your application is contingent on there being enough space. If we run out of space preference will be given to those who were in our camp last year and their friends.

Camp Roller Disco Member Sign-Up Form

My Playa Name (or nickname, if any)

First Name:

Last Name:

Email:

Please make this my Roller Disco Email Alias

Phone:

How many people in your party?

Pull down for selectionJust meMe and one other personMe and two other peopleMe and three other peopleI have a group of people -- lets talk

Level of Participation Pull Down For SelectionI want to be a HelperI want to be an Organizer

Where do you want to camp?

Pull Down For SelectionI want to stay in Satelite CampI want to stay in the Theme CampI plan to stay outside the Theme CampI'm not sure yet -- I'll take what's available

How would you like to participate?

I want to help load the Roller Disco  I want to help Build the Roller Disco  I want to take a shift at the Roller Disco  I want to help decorate the Roller Disco  I want to help Load the Desert Nose Truck  I want to help Build the Desert Nose  I want to help take down the Desert Nose  Other (Please describe below)

Other ways you'd like to participate?

When do you plan to arrive on the Playa?

Wed Aug 21 (before opening)Thu Aug 22 (before opening)Fri Aug 23 (before opening)Sat Aug 24 (before opening)Sun Aug 25 (before opening)Mon Aug 26 (opening day)Tue Aug 27Wed Aug 28Thu Aug 29Fri Aug 30Sat Aug 31Sun Sep 1 (closing day)Mon Sep 2 (after closing)Tue Sep 3 (after closing)

When do you plan to leave the Playa?

Thu Aug 29Fri Aug 30Sat Aug 31Sun Sep 1 (closing day)Mon Sep 2 (after closing)Tue Sep 3 (after closing)

What size is your vehicle?

No vehicle -- I'm riding with someone else.One compact car or pickup.One fullsize car.One van, SUV or fullsize truck.One 14 foot box truck (moving van)Large Box Truck (please describe)

Description of vehicle(s) if needed

Do you have any art projects that will need space in camp? Please describe:

Do you have any other space requirements?

Check all that apply:

I'm looking for a ride  I can offer a ride to someone  I need a ticket  I have an extra ticket  I would like to caravan with other vehicles  I can't wait until Burning Man!

I want to be on the camp email list

Yes  No

A picture of me/my group

Pull down for selectionI'll send images to Howard by EmailBelow is the URL of an imageI'll send Howard a photograph in the US mail

URL of image

How did you find this web site?

Pull down for selectionA friend Sent me a linkThe Sfskaters listThe Nose listRandom BrowsingInternet Search