Group/Department Name

Faculty/Staff Contact

Name

Title

Department

Phone

Departure from Bradley University

Return to Bradley University

Lodging Facility Information

Note: If group is staying at more than one lodging facility, please complete a separate form for EACH facility.

Name

Address

City

State

Postal Code

Specific floor(s), room number(s), or unit numbers(s) occupied

This trip is

a one-time triprepeated each semesterrepeated annuallyother

If other

If repeated, our group

always stays at the exact same lodging facilityuses various lodging facilities with each trip

Person submitting this form

Signature

Date