Wyland Clean Water Challenge

Wyland Clean Water Mobile Learning Center

Request Form

Organization Name: *
Contact Person: *
Address:
City: State: Zip:
Phone: *
Fax:
E-mail:
   
Event Name:
Event Location: *
Nature of Event: *
Location Address:
City: State: Zip:
Event Dates: *
Event Times:
Estimated Attendance: *
   
 

Yes/

No

   Staffing and Logistics
Will you have an educator? (Wyland educators are available at an additional fee).
Is the space on level ground?
Is there a water source with a hose attachment capabilities near the space?
Will you be providing odd shore electrical power?
If you require the trucks generator for power, the space requirements are 83'2" length x 22' wide.
Without the generator the total length is 56'2". Can you accommodate this space requirement?
 
How many staff or volunteers will you be providing?

What type of security will you be providing?


What day and time will the truck be able to set up and tear down?
(Set up and tear down time is approximately 3 hours)