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Materials Request Form

Today's Date:

Your Information

First Name:		M.I.:
Last Name:
Street Address:
Address (Cont'd.):
City:
State (USA):
Province (non-USA):
Zip/Postal Code:
Country:
Phone Number (USA):		- -
Phone Number (non-USA):
Email:

Event Information

What is the event?

Date of event:

How many people are expected to attend?

Which program(s) will be represented?		RDP ADP MAP all

What is the target audience?		(i.e. students, mentors, peers, etc.)

Is there a special area of interest that will be highlighted? (i.e. Adventure-based Psychotherapy, Adventure Ed, Teacher Ed, etc.)

Materials Request

Will you be staffing a table where materials can be displayed? Yes No

Date you wish to receive your materials:

Are you dropping materials off somewhere or with someone? Yes No

If yes, please enter their contact information below...

First Name:		M.I.:
Last Name:
Street Address:
Address (Cont'd.):
City:
State (USA):
Province (non-USA):
Zip/Postal Code:
Country:
Phone Number (USA):		- -
Phone Number (non-USA):
Email:

*Please note that all materials that are property of the Admissions office will need to be returned to the Admissions office – those requesting materials are liable for materials. Any excess materials will also need to be returned.



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