Team Building Program Request Form

Organization or Group Name

Group Type

UI Affiliated Group/Organization

UI Student Groups, Faculty/Staff Departments

Community/Non-Profit

Corporate

Contact Person

Mailing Address

City, State, Zip

Phone Number

Email Address

Program Preference

Portable Team Building (2 Hours)

Low Elements Only (3 Hours)

High Elements Only (3 Hours)

Low & High Elements (4 Hours)

Low & High Elements (6 Hours)

Preferred Event Date and Time

Second Preferred Event Date and Time

Third Preferred Event Date and Time

Anticipated number of participants (12 participant minimum charge)

Participants with special needs

Reason for event

Age Range of Partcipants

Please choose three areas you would like to focus on:

Communication

Respect

Confidence

Conflict Resolution

Play/Fun

Teamwork

Problem-Solving

Trust

Billing Person (if different from above)

Billing Address (if different from above)

Billing Email Address (if different from above)

Billing Phone Number (if different from above)

Preferred Payment Method

Check

Credit Card

We will send you a link to pay via credit card.

MFK

If paying by MFK, please provide MFK information here.