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THE DEADLINE FOR PRE-REGISTRATION IS May 8, 2009.
WWII Days
May 15-17, 2009
Fort Benjamin Harrison State Park
Indianapolis, Indiana 46216
REGISTRATION FORM
PLEASE PRINT
Name: ______________________________________________________________
AD DRESS:___________________________________________________________
_____________________________________________________________________
Email:_______________________________________________________________
HOME PHONE:________________________________________________________
UN IT:________________________________________________________________
ORGANIZATION:______________________________________________________
Are you bringing
Class 3 Weapons:_______________Yes/No___________
Are you bringing any military vehicles:____________Yes/No___________
PRE-REGISTRATION FEES
Please Check Selection
___Plan A: $5.00 - includes battle fee & camping.
__Plan B: ____STAFF/VOLUNTEER – Living History Only___UMPIRE ONLY-ALL
FEES ARE WAIVED FOR STAFF/VOLUNTEERS AND UMPIRES. MUST
PARTICIPATE WITH PUBLIC DURING LIVING HISTORY EVENT!
Barrack Space: Yes _____ or No _____
NOTE: Barrack space is available and will hold 80
people (first come, first served basis). NO BUNKS!
$________ TOTAL ENCLOSED
___I can not help ___I Volunteer to:
___assist event HQ ___work check-in
___inspect safety ___inspect authenticity ____Provost Company
Make your check/money order payable to the Fort Harrison Steering Committee.
DO NOT SEND CASH! MAIL THIS FORM AND YOUR CHECK/MONEY ORDER TO:
TSG Inc., 3818 15th St., Apt A, Moline, IL 61265
DEADLINE: For registration is May 9, 2009. (must be received by)
WAIVER OF LIABILITY
I (print name)________________________________ do hereby release from any and
all liability the Fort Harrison Steering Committee, TSG, Inc., and the DNR for any and all
injuries to myself or any damage or loss to my property which may occur while I
am involved in the activities or events of the Fort Harrison Steering Committee
on the dates of May 15-17, 2009.
I acknowledge that there may be certain dangers which can be associated with a
reenactment of any military maneuver or combat encounter such as the event
indicated above and I accept these dangers voluntarily, my participation being
of my own free will. In signing this Waiver of liability, the undersigned person
acknowledges that they have read and understood the rights waived herein and
that a copy of this form has been offered to them.
Signature_________________________________________________________________ ____
Address________________________________________________________ ______________
Date Signed__________________________________________________________________
If participant is a minor, Parent/Guardian must sign below
______________________________________________________________ ________________
Parent/Guardian Printed Name Signature Phone # Date
Authorization of Emergency Medical Care
I (print name)________________________________ do hereby authorize the Fort
Harrison Steering Committee or their agents to authorize emergency medical
treatment on my behalf in the event that I should any injury or suffer any
medical distress while participating in this event. It is understood that this
is not a transfer of liability or responsibility to the Fort Harrison Steering
Committee or their agents arising from said treatment, but is intended to
authorize medical care on my behalf in the event that I am unable to provide for
myself.
In signing this authorization of medical care, I hereby acknowledge that I have
read the above and that a copy of this form has been offered to me.
Signature___________________________________________Date Signed______________
Notify_________________________________________(___)__________________________
If participant is a minor, Parent/Guardian must sign below
______________________________________________________________ ________________
Parent/Guardian Printed Name Signature Phone # Date
PLEASE NOTE ANY UNUSUAL MEDICAL CONDITIONS BELOW.
_____________________________________________________________
______________________________________________________________________
___________________________________________________________