Organization *
Event Planner Person *
Event Planner Phone Number *
Event Planner Email Address *
Day-Of Contact Person *
Day-Of Contact Phone Number *
Day-Of Contact Email Address *
PTAO Billing Code for UVA Organizations – Please put N/A for groups not affiliated with UVA: *
Preferred Date *
Alternate Date *
Preferred Event Time – Start and End (half-day programs up to 4 hours, full-day programs up to 8 hours): *
Anticipated Number of Participants – Please note that final participation numbers can be updated up to 48 hours before the day of the program: *
Basic Demographics of the Group (Age, General Background, Gender, Personality etc.): *
How well does this group know each other? *
In the event of inclement weather, would you like to reschedule or move the program to an indoor location? *
Goals and Additional Information – Please tell us about the group so we can be best prepared and customize the experience to your group. What are your goals for the experience (Leadership, Trust, Communication, Conflict Resolution, Equity, Accountability etc.)? Is there anything course staff should know about the group? Are there any challenges that might arise? Accessibility needs? *
How you found out about us? *
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