To apply, print out and complete this form, and mail it with deposit to:

Name: ______________________________________________________________________________

Address: ____________________________________________________________________________

City: ___________________________ State: ___________ Postal Code: ________________________

E-mail Address: ______________________________________________________________________

I am at least 18 years old: YES:____ NO: ____     Phone number: (________) ________-___________

Known medical conditions and/or Allergies_________________________________________________

____________________________________________________________________________________

Emergency contact: Name: _____________________________________________________________

Address: ____________________________________________________________________________

City: ___________________________ State: ___________ Postal Code: ________________________

Phone number: (________) ________-___________

Select a Program:

____ Bronze Spike ($85.00 = $50.00 Program Fee plus $35.00 Individual Memberhip)

____ Silver Spike (Weekends only, $145.00 = $110.00 Program Fee plus $35.00 Individual Memberhip)

____ Gold Spike (Weekends only, $185.00 = $150.00 Program Fee plus $35.00 Individual Memberhip)

Requested dates: 1^st choice: ____/____/____   2^nd Choice: ____/____/____   3^rd Choice: ____/____/____

Method of Payment: ____ Cash     ____ Check     ____ Visa/MasterCard     ____ American Express

Account Number: __________________________________ Expiration Date: _______/_______

Signature and Name (printed) as it appears on card:___________________________________________

• A deposit of 50% will be required to reserve a date. Dates are not guaranteed until a deposit is received.
• Deposits are nonrefundable once a date is confirmed by the Gold Coast Railroad Museum, except as below.
• Deposits may be refunded, or dates may be rescheduled, only if equipment failures or other extenuating circumstances prevent the Museum from honoring the reservation.
• Dates are subject to availability and equipment is subject to change.