Group Request Information Form Thanks for your Interest! After filling out the form below, we will be in touch shortly to discuss your booking. Name of group or school*Breifly describe the nature of your group (e.g school, church or family)Primary contact* First Last Contact Email* Enter Email Confirm Email Contact Phone*Work Phone*Address of group, school or business* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCÃ´te d'IvoireCroatiaCubaCuraÃ§aoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Preferred Start Date Prefered Arrival Time* : HH MM Preferred End date Prefered Departure Time* : HH MM Are your dates flexible?YesNoHow many youth?How many adults?How many meals will Takodah provide*None1 meal2 meals3 meals4 meals5 meals6 meals7 meals8 meals9 meals10 meals11 meals12 meals13 meals13+ mealsWhat are your groups needs? All inclusive program (lodging and meals) Facility rental only (Dining Hall, Kitchen etc) Facility rental with a partial programming Wedding Event What are your groups primary interests? Please select all that apply. Teambuilding & Leadership Programming High Ropes Course Low Ropes Course Waterfront Access (Swimming, boating etc) Nature Hikes Evening Programs Camp Fires Use of Sports Equipment & Facilities Meal Service Self cook (with use of the kitchen) None - Just facility rental Age of groupMixed youth (12-21)Mixed adultsYouth Grade 4-5Youth Grade 6-7Youth Grade 7-8Youth Grade 9-10Youth Grade 11-12College groupUniversity groupAll agesPlease describe any additional requests or interests your group has.Are you Takodah Alumni?YesNoHow did you hear about us?*THANK YOU. We are delighted to hear from you. This form will be sent to Peter Simmonds (Director of Educational Programs) at firstname.lastname@example.org. We look forward to being in touch.NameThis field is for validation purposes and should be left unchanged.