| Primary Contact Information: | |
| First Name: | |
| Last Name: | |
| E-mail Address: | |
| Phone Number: | |
| Secondary Phone Number: | |
| Street Address: | |
| City: | |
| State: | |
| Zip Code: | |
| Secondary Contact Information: | |
| First Name: | |
| Last Name: | |
| E-mail Address: | |
| Phone Number: | |
| Secondary Phone Number: | |
| Street Address: | |
| City: | |
| State: | |
| Zip Code: | |
| Group Information | |
| Group Name: | |
| Number of Participants: | |
| Pricing/Budget | |
| What is your budget for this event? (not required) | |
| Scheduling | |
| First Potential Date (Month/Day/Year): | |
| Time Span of Event: | |
| Second Potential Date (Month/Day/Year): | |
| Time Span of Event: | |
| Third Potential Date (Month/Day/Year): | |
| Time Span of Event: | |
| Catering (lunchtime is 30 minutes long unless otherwise requested): | |
| Please select your preferred catering option: | |
| Please select preferred snack and beverage options. You may pick more than one. |
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| Catering Company Options: Please check all that apply |
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| Paper Products: Please check all that apply |
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| T-Shirts | |
| Would you like to order T-shirts for your group? |
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| If yes, we can add your group's logo to the sleeve for an additional fee. Upload logo here: | |
| Focus Areas | |
| Please select any areas you'd like us to focus on with your group: |
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| Please list the top five focus areas from above, beginning with the most relevant: | |
| Please select the activity or activities that your group would like to participate in: |
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| Evaluations | |
| We seek to provide a top-notch experience for your group and the evaluations help us to do so. | |
| We always issue customer service evaluations to provide us with much needed info about our events. | |
| We also provide professional evaluations that allow you to see the impact the experience had | |
| on your group. Using a pre, post, and post-post assessment, the evaluation tool measures | |
| cognitive, affective, motivational, and relational changes. | |
| Would you like to know more about this? |
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| Previous Teambuilding Experience: | |
| The following questions allow our staff to customize your event. Please be as specific as you can. | |
| Has this group done teambuilding/retreat type activities in the past outside of the BRIDGES Center? |
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| If so, please give some examples and explain the outcome(s): | |
| Describe the group that will be coming to the BRIDGES Experiential Learning Center for teambuilding: | |
| Is there anything else that is significant about this group that will assist us in planning? | |
| What is your ultimate goal for this group? | |
| Is everyone expected to participate in this event? (ie. Are there participants with physical, | |
| mental, or emotional limitations that we should be aware of?) |
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| If not, why, who, and what will their role be? | |
| Would you like any follow-up to this event (sequential in nature or a touchback with the group)? |
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| If so, what do you have in mind? | |
| Other Information? | |
| Is there anything else you would like to share? | |