4%

Team Up Program Request Form

Questions marked with a * are required

Please refer to the Team Up website before accurately filling out the request form below. If there are any questions or concerns you may have, please contact Stephie Daquioag @ (949)-824-1352 or sdaquioa@uci.edu.

Next Question

Lead Contact (First, Last Name)

Next Question

Phone Number

Next Question

Email Address

Next Question

Group Name

Next Question

Group Type

UCI Student (Student Organization)

UCI Faculty / Staff (Campus Department)

Community Group

Corporate Group

Are you a Returning Client?

No

Yes

How did you hear about us? (Click all that apply)

Repeat Customer

Word of Mouth / Referral

Social Media (Facebook, Instagram, Tiktok)

Vendor Fair / Event

Work / Organization

Internet Search (Google, Yelp, etc.)

Advertising / Marketing Material

Other

Next Question

Group Size

Next Question

Group Age Range

Next Question

Brief Description of Group / Organization (Let us get to know you!)

Next Question

Average number of months / years group members have worked together

Next Question

Health / Medical conditions you would like for us to know about / take into consideration. (Pre-existing, chronic, current, etc.) (If you do not wish to answer this question, please type 'NA' to continue the request form.)

Next Question

Powered by QuestionPro

Loading...