DISCOUNT RESERVATION SIMPLE RATE FORM

SCHOOL GROUP, GRADES (7-12) = $12.00 PER PASS

 

FAX TO:  (719)-689-2070     Phone-in TO:  (719)-689-2466

 

STEP 1) ----  Choose Edit > Select all

 

STEP 2) ----  Choose Edit > Copy

 

STEP 3) --- When E-mail window opens > Click on message pad > Choose Edit > Paste

                         (Click Here to open E-mail window )  - - - - >   molliegold@rmi.net

 

STEP 4) ---- Completely answer all question below.

          

          A)  SCHOOL NAME  [     ]

                GRADE  [     ]

                ADDRESS [     ]

 

                PHONE NUMBER  [     ]

                FAX NUMBER  [     ]

                E-MAIL  [     ]

 

          B)  CONTACT PERSON  [     ]

                PHONE NUMBER  [     ]

                FAX NUMBER  [     ]

                E-MAIL  [     ]

 

           C)  DATE / DAY YOU PLAN TO ATTEND  [     ]

                TOUR TIME YOU ARE SCHEDULING  [     ]  AM  [     ]  PM  [     ]

 

           D) NUMBER OF STUDENTS TO ATTEND                          [     ] x $12.00 = [     ]

1.            NUMBER OF TEACHERS/ESCORTS TO ATTEND       [     ] x $12.00 = [     ]
   

2.            TOTAL-------------------------------------------------------------------------------------[     ]
   

3. 
   

STEP 5) ---- SEND E-mail (FORM)

STEP 6) ---- OUNCE YOU RECEIVE A CONFORMATION SEND PAYMENT TO:

 

MOLLIE KATHLEEN GOLD MINE                              

1 MILE NORTH HIGHWAY 67

P.O. BOX 339

CRIPPLE CREEK, CO 80813  0339

 

TO VALIDATE CONFIRMATION AND RECEIVE THE GROUP DISCOUNT RATE

PREPAYMENT MUST BE RECEIVED, AT THE ABOVE ADDRESS, NO LESS THAN

14 DAYS PRIOR TO THE SCHEDULED TOUR DATE.