General Visit & Teacher-Led Group Reservation Form - U.s. Department Of The Interior

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General Visit & Teacher-led Group Reservation Form
Date:
______________________
Arrival Time:
________
Leave Time:
__________
Type and number of vehicles:
bus
_______
car
_______
van
_______
Number of Participants:
_______________
Age Level
_______________
Reason for visit: (Check all that apply below)
Interpretive Center
Lighthouse in small groups (<8)
Cobble Beach/Tidepools
Orientation
Junior Ranger
Salal Hill
Quarry Cove
Other
Description:
__________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Special Requests / Comments: ___________________________________________________
____________________________________________________________________________
Group Name:
_________________________________________________________________
Leader /Coordinator Name:
______________________________________________________
Address:
_____________________________________________________________________
Phone #:
(
) __________________________
Cell
(
) __________________________
Email:___________________________________________
Send completed form to: blm_or_yh_education@blm.gov or fax to 541-574-3140
*********************************************************************************************************************
For office use only:
Registration received: ____ / ____ / ____ Initials: ____ Confirmation: ____ / ____ / ____ Initials: ____
Waive entrance fee?
To be
Yes
No
determined
ASSIGNED CONTACT / ORIENTATION RANGER: _______________________________________________
Special Instructions: ___________________________________________________________________________
___________________________________________________________________________________________________________________
Ranger Comments/Evaluation: ___________________________________________________________________
___________________________________________________________________________________________________________________
Revised – 8/24/2017

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