Walk for the Log Cabin 2015
                                                                                      Saturday, May 30th
                                                                in the morning before Open House of Log Cabin Village
                                                                                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 $25; Event Day $30
                                          School Age or Team of Two or More - Pre-Registration $20; Event Day $25
                                  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

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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.

• Please PRINT and SIGN for liability and waiver purposes.

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

Signature ________________________________________ Date: __________________________

Walk Time: 9:00

T-Shirt Size (Circle one): S M L XL XXL (Received by Tuesday, May 26th 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: logcabinvillage@hotmail.com or www.logcabinvillagequincyil.com