1. Name ______________________________________________________________________

C.B. Radio nickname _____________________________________________________________

Those accompanying me: __________________________________________________________

Address _______________________________________________________________________

City, State, Zip __________________________________________________________________

E-mail ________________________________________________________________________

Phone _________-_________-____________, Cell Phone _________-_________-___________

Website _______________________________________________________________________

3. Insurance required. I and my vehicle are fully insured.     Yes     No

4. Riding with someone else - you still must sign Liability Waiver and fill in application.
I will be riding with ______________________________________________________________

5. I plan to arrive at Fulton County Museum: date & time ______________________________
I will camp at FCHS _______ I will stay in motel - give name ______________________________
I will camp at local campground - give name ___________________________________________
Note: FCHS has no electrical nor water hook-ups. Local campgrounds & lodging list available on request.

6. I will attend the Trail of Courage Living History Festival Sept. 20-21. Cost $7 adults. Or you can work for FCHS a four-hour shift and earn free admission: Indian dancer ____ ; PTDA booth ____; Speaker _________; FCHS food booth ____; host in museum or historic building _____; other _______________________________

7. Volunteer to give presentation (history talk, traditional craft demonstration, or music) to school groups on Friday Sept. 20: I alone ___ My group (name) ______________________________________
will present ____________________________________________________________________
I will help as a volunteer Friday to help with whatever needs to be done. ____

8. NO DOGS or other animals allowed except those assisting handicapped.

9. I give my permission for FCHS to use any pictures of me and my outfit and camp at the Trail of Courage and/or on the Trail of Death Commemorative Caravan on the FCHS web page or to be published in newspapers and newsletters.

10. Liability Waiver: I waive and release the Fulton County Historical Society and its Potawatomi Trail of Death Assn., its agents, representatives, officers, committees and members from any and all claims or rights to damages for injuries or losses suffered by myself and/or members of my family, directly or indirectly while participating in the Trail of Courage Living History Festival and all its activities, including the Trail of Death Commemorative Caravan. I alone am liable for loss, damage, or injury to myself and my property and damage to others and their property by me, my property, family and pets while participating in the Trail of Courage Living History Festival and the Trail of Death Commemorative Caravan.

Signature ________________________________________________ Date _________________

Spouse’s signature _________________________________________ Date _________________

This must be dated to be a legal signature!

I enclose the following:

___ My check for $20 per person or $30 per couple made payable to PTDA, Fulton Co. Hist. Soc., Rochester, IN 46975.

___ I also want to join the FCHS Potawatomi Trail of Death Assn. and receive the newsletters, which will include the Trail of Death Commemorative Caravan news & pictures afterward, cost $20 year. Add to above and enclose check.

___ Self-addressed long (4 x 9 1/2) envelope stamped with 65 cents for reply. We send a lot of material and it won’t fit in a little envelope! All registrants will receive a written reply on or before Sept. 15.

___ Photo of myself & others accompanying me in historic regalia (if possible).

I want the Trail of Courage to grow and be successful so:
___ I will help to publicize the Trail. Send me 10 brochures to pass out to relatives, friends, schools, church classes, traveling, other events, wherever I go. (Order more when these are gone, if you can get them out to people.)

In case of Emergency, while on the caravan, please notify:

Name _________________________________________________________________________

Address ______________________________________________________________________

City, State, Zip _________________________________________________________________

Phone _________-_________-___________, Cell Phone _________-_________-___________

___ I am an EMT, nurse, doctor or other medical person & willing to help in case of emergency.

___ I have a CB radio. Note: a CB radio is necessary on the caravan to communicate with the leaders and the group, get directions and history, find your way back to the caravan if you get separated, etc. Basic CB radios are about $50 at Walmart or Radio Shack.