ECO BUS Request

ECO BUS Request

Parks and Recreation Department
Anyone who submits a form should be aware that in accordance with the North Carolina Public Records law, found in North Carolina General Statutes Chapter 132, their e-mail address is considered public record.
Name*

First NameLast Name
Organization*
Event location*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Billing address same as event location*

YesNo
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*

Area CodePhone Number
Preferred event date *

MonthDayYear
*Preferred event date is not official until you receive confirmation from staff
Preferred program start and end time*

:HourMinutesAM/PM Option
and ending at
until :HourMinutesAM/PM Option
Which program are you interested in?*

TablingEco BusAnimal program at our Lake Higgins classroomClassroom event at your organizationGuided Nature walk at Lake BrandtOther
Number of participants/students*
Age of participants*
Please describe*
Should be Empty: