Battery Park, New York, NY 10004 . Liberty State Park, Jersey City, NJ 07305 201-432-6321 Statue of Liberty/Ellis Island Immigration Museum Statue Cruises Tour Operator/Schools Group Form (now with audio tour included!) School/ Operator Company Name: ______________________________________________________ Address: ___________________________________________________________________________ Teacher /Operator Main Contact Name:______________________________Phone:______________ Cell Phone: ______________ Fax:_______________Email:___________________________________ Departure Location: ____ Liberty State Park, NJ or ____Battery Park, NY Please select one: __Reserve Time Ticket: Specify Arrival Date _____________ Time __________ Pedestal Passes? Y/ N (free access inside pedestal of Statue of Liberty, subject to availability) __3-Day Flex Ticket: Specify Arrival Start Date ____________________________ Optional- 9/11 Museum: __ 2:30pm __ 4:30pm (Passes must be pre-paid at time of booking. Group Sales will contact you for payment. 911 Museum Passes are non-refundable.) Ticket Type Price Number of Requests Total Statue of Liberty/Ellis Island *Students (K-12, traveling as a school) $9.00 X = $ Children (Age 4-12) $9.00 X = $ *Chaperones (1 for every 10 students) $9.00 X = $ Adults $18.00 X = $ Seniors (62 +) $14.00 X = $ 911 Museum 911 Museum Adult $24 X = $ 911 Museum Senior $18 X = $ 911 Museum Child $15 X = $ Liberty Landing Commuter Ferry between Liberty State Park, NJ and World Financial, NY One Way $5.00 X = $ Roundtrip $7.50 X = $ Wall Street Experience Combo: Walking tour of Wall Street with Statue of Liberty Adult $28.00 X = $ Child/Student/Chaperone $19.00 X = $ **Shipping = $ Total = $ Battery Park, New York, NY 10004 . Liberty State Park, Jersey City, NJ 07305 201-432-6321 *One adult over the age of 21 years old is required per every 10 students. Only the required number of adult chaperones will be eligible for the discounted rate. Please send a school letterhead to email@example.com or fax to 201-432-1801. Reservations must be paid for two weeks prior to the trip date. Be advised that all purchase orders must be paid in full two weeks prior to trip date. Comments or Any Special needs for your Group: ______________________________________________________ __________________________________________________________________________________________________________________________________________________________________________________________ Ticket Delivery Method: ___ E-ticket (45 tickets and under only) ___ Will Call Pickup ____ Mail (see below) **Shipping charges: $8 First Class Mail/$25 FedEx 3-Day Delivery/$50 FedEx Overnight/$10 handling with customers FedEx account # provided. A confirmation of your order will be sent via e-mail. If you do not receive a confirmation within 2 business days please call 201-432-6321, Group Sales. I agree to provide one adult leader (over 21 years of age) for every 10 youths below the age of 21, who must remain with the group. Visitors with the group who are 18-20 years old do not qualify as chaperones. By submitting this group information and ticket request form, I agree to follow all rules and regulations established by the National Park Service for the operation of the Statue of Liberty National Monument and the Ellis Island Immigration Museum. __________________________________ __________________________________ Contact Name Todays Date Please email your order form to firstname.lastname@example.org for processing. OR Fax it to us at 201-432-1801. Please call us at 201-432-6321, group sales for further assistance Thank you!