Registration Form

                                                                Walk for the Log Cabins 2013
                             Saturday, September 14th (in the morning before Frontier Settlement Day activities)
                                                                      Help Save These Historic Cabins!
                         Raise money as an Individual or as a Team!
                             Prizes for raising a minimum of $50
     Entry Ticket in Raffle for Larger Prizes, One for each additional $50 raised
                      (Prizes listed & Registration Form available on web site at: www.logcabinvillagequincyilcom
PARTICIPANT RELEASE
  In consideration of my signing this agreement, I for myself, my heirs and administrators assume any and all risks
  which might be associated. I waive and release any and all rights and claims for damages which I may have against
the Friends of the Log Cabins Association or any of the sponsors, officers and members, and any other persons
connected with this event, their sponsors, representatives, successors and assigns for any and all injuries or
damages of any kind and whatsoever suffered by me as a result of taking part in this event and any related activities.
I hereby for myself, my heirs and administrators, agree to indemnify and save and hold harmless the release and each
of them from any loss, liability damage or cost they may incur due to whether caused by negligence of the release or
otherwise. I grant Friends of the Log Cabins Association the permission to disclose my (or my child's) identity and to
reproduce and distribute videotapes, films, photographs and transparencies of me (or my child) and sound recordings
arising out of documenting Friends of the Log Cabins events.

Please PRINT and SIGN for liability and waiver purposes.

Print Name: _____________________________________________________________________
(Print - Name, Address, Phone Number & Email - if have one)

Signature ________________________________________ Date: __________________________

Preferred Walk Time (Circle One): 9:00 9:30 10:00 10:30

T-Shirt Size (Circle one): S M L XL XXL (Must send in by Tuesday, September 3rd for T-Shirt)

Send completed Registration Form to: Friends of the Log Cabins, P.O. Box 3122, Quincy, IL 62305
Question? (217) 223-7703 or Email: avtvman@hotmail.com or www.logcabinvillagequincyil.com
.