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!
                                                                             Every Entry gets a Souvenir T-Shirt!
                                                             Adult Individual: Pre-Registration $20; Event Day $25
                                          School Age or Team of Two or More - Pre-Registration $15; Event Day $20
                                  For every $25 raised, above initial entry fee, gets an entry Ticket in Raffle for Prizes!
                            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