BACKCOUNTRY RESERVATION REQUEST FORM

GRAND CANYON NATIONAL PARK
BACKCOUNTRY RESERVATION REQUEST FORM

                                                            |------ Office Use Only ------|
Please tell us what to do when space is not available.      |                             |
                                                            |_____________________________|
  [  ] Do not look for variations.                          |                             |
  [  ] Try any variations to trip CAMPSITES.                |_____________________________|
  [  ] Try all start dates between ________ and ________.   |                             |
                                                            |_____________________________|


Name: __________________________________ Home Phone: ____________ Work Phone:  ____________

Address: _______________________________ City: _________________  State: _____ Zip: _______

Organization: __________________________ Number of People: __  Number of Stock (horses): __

1st Vehicle: State: __ Lic Number: __________ 2nd Vehicle: State: __ Lic Number: __________

Method of Payment: [ ] VISA [ ] Mastercard
Credit Card Number Expiration Date Total Authorized Permit Cost: __________ ______ ______ ______ ______ _____ / ____ Charge is $10 plus $5 per person, per night. month year [ ] In place of the $10 above, enroll me in the Frequent Hiker Program for $25 for a year.
Signature: ______________________________ Date: _____________
FIRST CHOICE
Mo./Da./Yr. of Night      Use Area/Campsite

1. ________________________________________

2. ________________________________________

3. ________________________________________

4. ________________________________________

5. ________________________________________

6. ________________________________________

7. ________________________________________
THIRD CHOICE
Mo./Da./Yr. of Night      Use Area/Campsite

1. ________________________________________

2. ________________________________________

3. ________________________________________

4. ________________________________________

5. ________________________________________

6. ________________________________________

7. ________________________________________
SECOND CHOICE
Mo./Da./Yr. of Night      Use Area/Campsite

1. ________________________________________

2. ________________________________________

3. ________________________________________

4. ________________________________________

5. ________________________________________

6. ________________________________________

7. _________________________________________
FOURTH CHOICE
Mo./Da./Yr. of Night      Use Area/Campsite

1. ________________________________________

2. ________________________________________

3. ________________________________________

4. ________________________________________

5. ________________________________________

6. ________________________________________

7. _________________________________________
IMPORTANT:  RESERVATION REQUESTS  for overnight backcountry hiking and camping are accepted
by  MAIL OR IN PERSON ONLY.   Beginning with the first day of a month,  permit requests are
accepted for a proposed trip  start date  in that month  and the following  4  months.  For
example,  beginning on December 1, 1993,  permit requests for any  start date through April
30, 1994 would be accepted.  The envelope postmark  will be the date  used to determine the
validity of requests received by mail.