March Registration Form

Copy, paste, and drop this information into an email, then send it to tackitthome@zipcon.net.   After that, send a hardcopy plus a check for ten dollars to :

Mark (Silas) Tackitt
PO Box 46330
Seattle WA 98146-0330

All net proceeds plus designated preservation dollars will be given to the Gettysburg National Battlefield Park. Gross proceeds will be applied to costs such as : rations, water, Wednesday night site fees, reasonable kabuki costs, and any other necessities.

[ ] I'm sending an extra five / ten / __________ bucks for preservation. (Circle one if you check the box.)

No walk-ons without prior approval by me! Although registrations may be emailed, THE SIGNED REGISTRATIONS AND CHECKS MUST BE POSTED BY 6 JUNE 08. 

Name  : _____________________________________________
Address : _____________________________________________
        _____________________________________________
Phone : (home) _______________________________________ 
       (cell) _________________________________________
Email :  (home) _______________________________________ 
       (mobile) ______________________________________

For contact purposes only, my company and battalion at High Tide is :
_________________________________________________________

I approximate time I expect to arrive at the High Tide event site is  ___________ o'clock am / pm (circle one). 

MEDICAL ALERTS
I have these medical issues, allergies and reactions worth mentioning :
__________________________________________________________________________________

EMERGENCY CONTACT INFORMATION :

Name   : ___________________________________________ 
Relationship : ________________________________________
Address    : ________________________________________
                    (city / state / time zone only)
Phone : (home) _____________________________
        (cell) _______________________________
Email  : (home) ______________________________  
       (mobile) _____________________________

IMPORTANT LEGAL MUMBO JUMBO :

I recognize that marching seventeen miles across trails, highways and streets on a hot Pennsylvania day has its obvious hazards. I'll be in sufficient shape to make this march. In consideration for allowing me to participate, I agree to bear all the risks incumbent with this carpe eventum march. I also agree to absolve, indemnify and hold harmless all other participants including drivers, food providers and other marchers from any and all possible liability. 

Signed : ______________________________________________________________________

Dated : _______________________________________

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This page hosted by Silas Tackitt and was last updated on 04 May 2008 20:08