Educator Travel Consent Form – BC WEEKReturn to Travel Sponsor/s

Event: Educator - Business Challenge June 13-16, 2010

Purpose of Travel: Business Challenge weekly activities_________________________

Travel Start Date: June 13, 2010 Travel End Date: __June 16, 2010__________

Sponsor/s Name: Katie Mehrer, Business Challenge Coordinator

Destination: Industry Site Tours/ Medora, ND__________________________________

Department/Unit: Business Challenge

Program/Organization: Business Challenge

Emergency Contact Relationship: Phone:

Special Needs -Medical or otherwise:

As a participant in the travel activity, I have been advised that participating in this activity, wholly or in part, carries with it certain risks. I understand the risks, accept those risks, and I am agreeing to freely and voluntarily participate in the project.

Participants Name (Please Print)

Signature Date

In Case of Emergency Call: Student Development: 701.483.2090 (day)Hal Haynes-VP Student Development: 701.590.1378 (evening)

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