Request Services

Event Visitation Request

Interested in requesting a Therapist at your next event? Please let us know.

Request for Therapist Participation

Event

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Lodge

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Description of Event

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Event Date

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Event Time

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Expected Number of Attendees

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Child and Family Requested

Yes

No

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Describe how Staff will be asked to participate

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Is Therapists Spouse invited

Yes

No

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Will Lodge be hosting Therapist Family for meals

Yes

No

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Is Audio Visual equipment available

Yes

No

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How long is the presentation expected to last

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Directions to Lodge or Event location

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Elk in Charge

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Your Email

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Home Address

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City

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State

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Zip

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Home Phone

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Work Phone

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Lodge Address

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City

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State

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Zip

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Name of Host

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