"*" indicates required fieldsName* First Last Cell Phone Number On Day Of Trip*Email* Please specify what type of group you are interested in bringing to the Currituck Beach Lighthouse*School GroupNon Profit GroupProfessionally Guided TourSchool Name*Grade Level*Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th GradeOther; Mixed gradesAddress* City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code School PhoneNumber of Students*Please enter a number greater than or equal to 15.(Minimum of 15 students)Number of Teachers*Number of ChaperonesAny Special Needs Or AccommodationsGroup Name*Number of Guests in Group*Address* City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Any Special Needs Or AccommodationsVisit Date – First Choice* MM slash DD slash YYYY Arrival Time* Hours: Minutes AMPM AM/PM(Plan to stay on-site for around an hour)Visit Date – Second Choice MM slash DD slash YYYY Arrival Time Hours: Minutes AMPM AM/PMVisit Date – Third Choice MM slash DD slash YYYY Arrival Time Hours: Minutes AMPM AM/PMPhoneThis field is for validation purposes and should be left unchanged.