PHSA FIELD/EVENT TRIP FORM

ORGANIZER INFORMATION:
NAME:_____________________________________________________________________________________
PHONE:____________________________________________________________________________________
EMAIL:____________________________________________________________________________________
RSVP by what date____________________________________________________________________

EVENT INFORMATION:
NAME OF PLACE:___________________________________________________________________

CONTACT PERSON:_________________________________________________________________

TIME and DATE:_____________________________________________________________________
DESCRIPTION:____________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

HOW MANY PEOPLE CAN YOU ACCOMMODATE?_____________________________________
AGE LEVEL OF PARTICIPATION:_____________________________________________________
DIRECTIONS OR PLACE TO MEET:____________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________

SPECIAL INSTRUCTIONS (WHAT TO BRING, WEAR, ETC.)
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________

THANK YOU INFORMATION:
PERSON:___________________________________________________________________________________
ADDRESS:_________________________________________________________________________________
_________________________________________________________________________________________

NEWSLETTER REPORTER:___________________________________________________________
Articles and field trip info. due to the newsletter person by 20th of the month.

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