Club Travel Request

Please fill out all the fields below completely and accurately. If you fail to fill out the form completely, your report may not submit correctly!

This form is due at least 48 hours before leaving Bloomington.

Club:	NOTE: Club Sports that are not listed in the drop down menu are inactive and are not allowed to travel.
Name of Event:
Date Leaving Bloomington:
Time Leaving Bloomington:
Date Returning to Bloomington:
Time Returning to Bloomington:
Destination (City/State):	City: State:
Vehicle:	*NOTE: If using a personal vehicle, all drivers must complete a vehicle authorization form, and show their driver's license and proof of required insurance to the Assistant Director of Club Sports and Intramural Sports.

Submitted by:
Email:
Contact Phone #:
Number of People Traveling:
Names of People Traveling:
Club Safety Officer Traveling: