You must have JavaScript enabled to use this form. Organization or Group Name Group Affiliation (input quantity of each type)* CSUSB Student CSUSB Faculty, Staff, Alumni Association Member Non Profit, as defined by the IRS (School Groups, Scouts, Government Orgs. Youth Orgs.) Not Affiliated with CSUSB Contact Person Mailing Address City State Zip Phone Email Program Options 2.5 hour - Lows 4 hour - Dynamic Course 4 hour - Teams Course 6 hour - Dynamic Course 6 hour - Teams Course Preferred Event Date (must be at least 14 days in advance from date of request) Second Date Choice Third Date Choice Preferred Start Time Second Start Time Choice Third Start Time Choice Anticipated number of participants Participants with special needs Reason for event Please choose three areas you would like to focus on Communication Conflict Resolution Decision making Play/fun Respect Teamwork Confidence Cooperation Exploring diversity Problem-solving Team Coordination Trust Additional focus needs Authorizing Person (The person who has the authority to sign agreements as representatives of their respective entities.) Authorizing Person Position Authorizing Person Email Billing Person (if different from above) Billing Address (if different from above) Billing Email (if different from above) Billing Phone (if different from above) Payment Preference - None -Credit/Debit transaction day of programCheck mailed or dropped off Purchase Order