Emergency Contact Information, Dietary Preference/Restrictions and Existing Medical Conditions or Physical Disabilities

Complete the form electronically or click here to download the form a send by mail. Please mail the form to:

USDETC
2471 TAMU
College Station, TX 77843-2471

The form must be submitted by April 1, 2019.

Emergency Contact Information
Your Name*
First Last
In the case of an emergency, the USDETC will contact the following individual(s).*
First Last
Relationship*
Phone*
Email*
Alternative Contact
First Last
Relationship
Phone
Email
Medical Conditions or Physical Disabilities
Please list any special services you may require due to an existing medical condition or physical disability:*
Please list any dietary preferences/restrictions. We will try our best to meet any dietary restrictions.*

U.S. Dairy Education & Training Consortium