Name of Group Contact Name Title Address City State Zip Phone (include area code) Fax (include area code)
Contact’s Home Phone Contact’s Email Address Contact’s Mailing Address State Zip
Dates Planned Arrival Date (MM/DD/YY) Planned Departure Date (MM/DD/YY)
Meals First Meal (B,L,D) Last Meal (B,L,D)
Number Attending Number Female Youths Number Male Youths Number Female Adults Number Male Adults
Requested Lodging
Facility Choose One Conference Center The Lodge Dormitories
Special Needs
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