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CCR Reservation Form

CCR Reservation Form

Fields marked with an asterisk (*) are required.



  • CCR Logo
    If this is your first time reserving a kit, please watch our orientation video before filling out this reservation form.

    For questions, please call (812) 941-2277, or send an email to ccr@ius.edu.

  • Contact Information

  • Name *
  • Address 1
  • Home Phone - -
  • Work Phone - -
  • Fax - -
  • Kit Information

  • Add a second Kit
  • Add a third Kit
  • Add a fourth Kit
  • Requested Dates

  • First Date Choice / /
  • Second Date Choice / /
  • Third Date Choice / /


  • For questions, please call (812) 941-2277, or send an email to ccr@ius.edu.

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