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UNIVERSITY EDUCATION FIELD TRIP REQUEST FORM

Name:
Office Phone #:
Cell Phone #:
Email address:
   
School/Organization:
School Address:
City: , State:    Zip Code:
Fax #:
   
Contact Person for Billing/Invoicing:
Phone #:
Email address:
Project#: (if applicable)
   
  Arrival and Departure Dates Requested (top 3 choices):


   
  Arrival Time to LUMCON:
  Departure Time from LUMCON:
   
  Number of Participants:
   
  Course name/ level (undergraduate or graduate) or group type:
   
  Accommodations: (Fees) Please indicate if you would like apartments for instructors or all dorm rooms.
   
  Meals: (Fees) Please indicate which meals you would like to have and dates. There is a 10 meal purchased minimum.
   
   
  Activities and Habitat/Location Preference(s): (Fees)
   
  Will you need a marine educator during field trip activities? (Fees)
   
       
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