EF-04

First Name

Last Name

Street Address

Address Line 2

City

State

Zip Code

Phone Number

Email Address

What type of Event is this to be?

Charity Run

Veterans Affair

Statewide Rally

Community Service Project

Number of anticipated Members participating?

What is the purpose of the event:, (Why are MTRA members attending)?

Do you have a contact person for this event?

Please list your Itinerary. (Date/s Time, Location, Fallback Plan, etc.

Who is involved in the planning stage? Check only those that apply..

Indicates Response Required