Reservation Request CompanyThis field is for validation purposes and should be left unchanged. Reason for visit:Reason*Please selectResearchInstructionOutreachConference/MeetingSTOP - you must complete the Project Information Request Form before you proceed further.Additional Information Needed for Research Visits:- List the names of all individuals who will be staying at Kemp Station during the dates of this request:Indicate with a check if you need any of the following to support your research: Lab bench space Refrigerator sample storage Freezer sample storage Equipment storage Office space If "Instruction", please provide course number and name (NOTE: Only university credit courses qualify as "Instruction" use):If "Outreach", please provide affiliation and activity (NOTE: Only events/activities open to or serving the public qualify as "Outreach" use.):If "Conference/Meeting", please provide affiliation and purpose:Contact Information:Contact Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Contact Email* Contact Daytime Phone*Billing Contact:* First Last Billing Email:* For UW-System users, provide driver worktag:Reservation Details:Requested arrival date:* MM slash DD slash YYYY Requested arrival time:* : Hours Minutes AM PM AM/PM Requested departure date:* MM slash DD slash YYYY Requested departure time:* : Hours Minutes AM PM AM/PM Total number of guests:*1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950Number of overnight guests (if different than total):*Same as totalNo lodging required1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950Anyone under the age of 18?*NoYes(If yes, a Release of Liability form must be submitted.)Will alcohol beverages be served during your stay?*NoYes(If yes, an Alcohol Beverage Permit Application must be submitted.)Will anyone in your group be bringing a pet?*NoYesType of Pet Dog Cat Name and email of person responsible for this pet:Special Lodging Room Assignment Needs:Lodging at Kemp Station is dormitory style, with 2-8 beds per room. Rooms in the Lodge or Mead Residence Hall, or the Cabin, will be assigned based on use and group size. If special needs exist to accommodate gender or family groups, for example, please specify:Facility Details:Indicate if you need one or more classrooms: Boathouse Classroom (Capacity 30) Office Conference Room (Capacity 12) Outdoor Pavilion (Capacity 40) Connor Forestry Center – Small Classroom (Capacity 35) Connor Forestry Center – Large Classroom (Capacity 60; 80 without tables) Δ
