Great Basin Rendezvous Sponsorship 2024 Great Basin Rendezvous Sponsorship Form Friday Sept. 6 - Sunday, Sept. 8, 2024 Royal Peacock Mine, NV Sponsor Name Company, Organization, or your name for individual contributionsSponsorship Purchaser Information* First Last Contribution Amount* Please enter the amount you would like to contribute towards a sponsorship of this year's Great Basin Rendezvous. Email* Home PhoneCell PhoneAre you a 2024 member of the NMEC?*YesNoWaiver: In consideration of the acceptance of the right to participate, I, the undersigned, as representative all participants listed above, by execution of this form, release and discharge the Nevada Mineral Exploration Coalition, Great Basin Rendezvous, the State of Nevada, the County of Humboldt, the City of Denio, the owners/operators of Royal Peacock Opal Mine and their officers, directors, trustees, employees, agents, representatives, volunteers, servants, and anyone else connected with the management or presentation of Great Basin Rendezvous of and from any and all known or unknown damages, injuries, illness (including Covid-19), losses, judgments, and/or claims from any cause whatsoever that may be suffered by participant to his person or property. Further, each participant expressly agrees to indemnify all of the foregoing entities, firms, persons, and bodies of and from any and all liability occasioned or resulting from the conduct of any and all participants. Participants agree that participation in any contests, games, or activities may be limited. Further, event management reserves the right to restrict participants to acceptable behavior during any and all activities of Great Basin Rendezvous. If, for any reason, a participant's or his/her guest's, appearance, conduct, or general health are deemed to be objectionable or a danger to others by event management, participant and his/her guest will be subject to eviction from the premises. This reservation includes persons, things, conduct, printed matter, or any act or item of poor character which the management considers objectionable to the event's well being. In the case of any eviction or restriction, Great Basin Rendezvous is not liable for refunding registration fees except at its own discretion. I have read and understand the conditions of this waiver.* Yes PaymentTotal $0.00 Billing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Expiration Date Security Code Cardholder Name CommentsThis field is for validation purposes and should be left unchanged. 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