College of DuPage - Nexlab: Storm Chase Info Sheet


Name:
Address 1:
Address 2:
Country
City:
State:
Zip:
Home/Work Phone:
Cell Phone:
Email:
1800 or 2800?: 1800 2800
Are you Ham Radio Certified?: Yes No
Are you CPR certified?: Yes No
Are you 21 years old or older??: Yes No
Note:
 

Trip Preference. Rank them from 1 being the most preferred to 5 the least. Mark an "X" on any trip you can't participate.
Trip 1
Trip 2
Trip 3
Trip 4
Trip 5