Walk for the Log Cabin 2014, Saturday, September 13th, (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
Registration Form
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.


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 (Received by Sunday, September 7th 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