Midwest World War Historical Society Event Registration Form.
Name:
Address:
Phone #:
E-mail Address:
Nationality:
Unit/Rank:
Bringing a WWII Vehical (Please Circle One): Yes No Type:
$10.00 Battle Fee Included (Please Circle One): Yes No Paid By (Please Circle One): Check Money Order
NOTE: Pre-registraion is mandatory!! The event is limited to 60 participants due to the size of the property. Vehicals will be limited to US Jeeps and/or German Kubel's/Motorcycles. WWII Artillery/Assault Guns are welcome also. There will be no late registraion at the gate!!!!
Attention: Registration Due No Later Then - February 28th, 2004!
There will be a $10.00 dollar battle fee charged at events to cover the cost of meals, facilities, and maintenance of the site and structures. Please make all checks/money orders payable to the Midwest World War Historical Society (MWWWHS) and send with waiver and registration forms to:
David Hartmann - President Midwest World War Historical Society
10157 Oak Ridge Road
Lancaster, WI 53813
Ph#: (608)-943-8458
Waiver of Liability
I (print name) _____________________________________ do hereby release from any and all liability The Midwest World War Historical Society for any and all injuries to myself or any damage or loss to my property which may occur while I am involved in the activities or events of the Midwest World War Historical Society on the property located at 10157 Oak Ridge Road Lancaster, Wisconsin 53813 on the dates of March 13th - 14th, 2004..
I acknowledge that there may be certain dangers, which can be associated with a reenactment of any military maneuver or combat encounter such as the event indicated above and I accept these dangers voluntarily, my participation being of my own free will. In signing this Waiver of liability, the undersigned person acknowledges that they have read and understood the rights waived herein and that a copy of this form has been offered to them.
Signature _______________________________________________________________________________
Address ________________________________________________________________________________
Date Signed _____________________________________
If Participant is a minor, Parent/Guardian must sign below.
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Parent/Guardian Printed Name Signature Phone # Date
Authorization for Emergency Medical Care
I (print name) _____________________________________ do hereby authorize the Midwest World War Historical Society, their agents to authorize emergency medical treatment on my behalf in the event that I should suffer any injury or suffer any medical distress while participating in this event. It is understood that this is not a transfer of liability or responsibility to the Midwest World War Historical Society, or their agents arising from said treatment, but is intended to authorize medical care on my behalf in the event that I am unable to provide for myself.
In signing this authorization of medical care, I hereby acknowledge that I have read the above and that a copy of this form has been offered to me.
Signature ___________________________________________ Date_______________________________
Notify ______________________________________________ ( )_____________________________
If Participant is a minor, Parent/Guardian must sign below:
________________________________________________________________________________________
Parent/Guardian Printed Name Signature Phone # Date
PLEASE NOTE ANY KNOWN MEDICAL CONDITIONS
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