Chimney Rock Gem Mine - Gem Mining NC Groups

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Group/field Trip Intake
Disclaimer – Please Be Sure To Review Our Group/field Trip Payment And Cancellation Policy Before Completing This Form.
School/Organization Name*
Name of Contact Person*
First Last
Contact Information
Address
Street Address Address Line 2 City State ZIP Code
Email*
Contact Phone*
Billing Address
Street Address Address Line 2 City State ZIP Code
Number of Students*
Grade Level*
Date Information
What Date and Time would you like to request?
(Please list your top 3 choices)
Date Option 1*
MM slash DD slash YYYY
Date Option 2*
MM slash DD slash YYYY
Date Option 3*
MM slash DD slash YYYY
Party Time Preference?*

: Hours

Minutes

AM/PM
Review & Confirm
Please review the Group/field Trip Payment And Cancellation PolicyBirthday Party Payment And Cancellation Policy before proceeding.
Do you agree with the above-mentioned policies.*
- I agree
Phone
This field is for validation purposes and should be left unchanged.

Group/field Trip Intake