<%@ Page Language="vb" EnableViewState="true" EnableSessionState="true" CodeBehind="loadForm.vb" Inherits="eSignProcess.loadForm"%> Field Trip Insurance Program


 

Field Trip Insurance
Risk Management
Environmental Studies 72, MS-9070
360.650.3065
Email: paul.mueller@wwu.edu

 

Field Trip Insurance Program

Field Trip Insurance Claims Instructions
 

FIELD TRIP INSURANCE ROSTER
Department/Organization
 
Contact Person (or person in charge) & Phone No.
 
Activity/Location
 
Activity Date(s)
 
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Number of Participants
Cost Per Participant per Day

$0.80
Number of Days
Total Payment
   
   

FOR CASHIER USE ONLY
 
For Deposit to: FSRMFT H191
 
(Please attach receipt or stamp this form and mail to Risk Management MS-9070. Thanks!)