If you are attending the 5th Annual Gathering of the Juggalos 2004 and have a physical condition that requires special accommodations that we would need to provide, please fill out the form below completely and accurately. All information is required so that we can both confirm that you will be at the Gathering and so we can contact you, if necessary, to work out specific details for your particular situation.

For those of ya that are bored and looking for something to fill out, this ain't it. This is for the people out there who actually need help, so if you're gonna just fill out random stuff, don't do it here.