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Climbing Wall Request Form
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Organization or Group Name
Affiliation with the University of Iowa
UI Student Group/Organization
UI Faculty, Staff, or Department
Not affiliated with the University of Iowa
Contact Person
Mailing Address
City, State, Zip
Phone Number
Email Address
Group Size
1-10
11-15
16-20
21-25
Other…
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How many climbers are 18 years or older?
Event Type
Birthday Party
Social Gathering
Team Development
Other…
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Preferred Event Date and Time
Preferred Event Date and Time: Date
Preferred Event Date and Time: Time
Second Preferred Event Date and Time
Second Preferred Event Date and Time: Date
Second Preferred Event Date and Time: Time
Preferred Payment Option
Blue Req
Cash
Check
Credit Card
MFK
Anything else we should know about your request?
Reason for event
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