Information Submission Form

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Name of person filling out this form (please print clearly): _____________________________________

MUSEUM, SITE, or INSTITUTION NAME ____________________________________________________

A subsidiary of / part of / located in: _______________________________________________________

Site address

Street: ___________________________________

P.O. Box (if any): ___________________________

City/State: ________________________________

Zip Code (9 digit, if known): ___________________

Phone #: __________________________________

Email: Address: ____________________________		 Mailing address (if different)

Street: ___________________________________

P.O. Box (if any): ___________________________

City/State: ________________________________

Zip Code (9 digit, if known): ___________________

Phone #: ____________    Fax #: ______________

Website: __________________________________
SITE TYPE AND ACCESS
[  ] Museum, tourist-mine, or staffed historic
site, etc.
[  ] Library/archive featuring mining literature/
records.
[  ] Unstaffed public site
   [  ] enterable (structures)  [  ] viewable
   [  ] no remains   [  ] with exhibits   [  ] no exhibits
[  ]  Working mine, ore docks, mills, etc.
   [  ]  Viewing platform or site
   [  ] Visitors welcome to enter the property (with
   permission) and view operations without appt.
   Tours for [  ] individuals, [  ] groups, by appt
   Minimum notice (days): ______		 Handicapped access:
[  ] mostly     [  ] partially     [  ] none

Groups
Minimum group size: __    Maximum group size: __

Minimum notice (days): _______________________

Other:  ____________________________________

__________________________________________

Hours of operation
Primary schedule

(month) ____  (date) ____  to (month) ____  (date) ____
Days & hours (circle the days applicable)

Mo Tu We Th Fr Sa Su ____  am/pm  to ____  am/pm

Mo Tu We Th Fr Sa Su ____  am/pm  to ____  am/pm
Secondary schedule

(month) ____  (date) ____  to (month) ____  (date) ____
Days & hours (circle the days applicable)

Mo Tu We Th Fr Sa Su ____  am/pm  to ____  am/pm

Mo Tu We Th Fr Sa Su ____  am/pm  to ____  am/pm
[  ] Open by appointment for individual visitors in
addition to times specified.

Closed:     [  ] Jan 1    [  ] Pres. Day    [  ] Easter
[  ] Mem Day    [  ] Jul 4    [  ] Labor Day     [  ] Col. Day
[  ] Thanksgvng    [  ] Vet. Day    [  ] Dec 25   [  ] Other		 Admission fees for individual visitors
[  ] Free (or unspecified “donation appreciated”)

[  ] Regular adult fee (or “donation”)  $ ___________

[  ] Per vehicle (State Parks, etc.)  $_____________

DESCRIPTIONS: Use additional sheets of paper as necessary.

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