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SGA VAN Request Form

Organization/House Name
Reserver's Name (include your title)
Contact Person Cell Phone
Contact Person Email
Destination Town and State
Purpose of Trip
Number of Vans	1 2
Driver 1	Cell Phone: SGA certified?
Driver 1 (backup)	Cell Phone: SGA certified?
Driver 2	Cell Phone: SGA certified?
Driver 2 (backup)	Cell Phone: SGA certified?

Keep in Mind:

• Two drivers per van are required for all trips, at all times, in case of the incapacitation of a driver.
• Three drivers per van plus backups are required for distances over 350 miles one way.
• All drivers must take a break every 3 hours, for at least one hour.
• No vehicle may be driven more than 12 hours in one 24 hour period.

Pickup Day
Pickup Date
Pickup Time
Return Day
Return Date
Return Time

I agree to abide by the policies and procedures outlined in the SGA Van Manual.

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