TRIP NAME:___________________________________________________

DESTINATION(if different):_______________________________________

DATE, TIME, &

LOCATION OF DEPARTURE:_____________________________________

DATE, TIME, &

LOCATION OF RETURN:________________________________________

ADULTS WHO

WILL BE GOING:______________________________________________

ROUTE GOING:________________________________________________

_____________________________________________________________

MILES TO DESTINATION AND RETURN:___________________________

GAS MONEY REQUIRED ($1.50 X EA. 50 MILES)____________________

EXTRA FEES REQUIRED_______________________________________

PERMITS REQUIRED:__________________________________________

TOUR PERMIT

FILED?____________BY WHO?________________DATE_____________

SPECIAL EQUIPMENT NEEDED:_________________________________

____________________________________________________________

SPECIAL CLOTHING NEEDED:__________________________________

____________________________________________________________

NEAREST CONTACT

FOR HELP:_______________________________phone_______________

NEAREST

HOSPITAL:_______________________________________phone_______

LUNCH MONEY FOR RETURN TRIP?_________