| NATIONAL PIKE WAGON TRAIN ASSOCIATION REGISTRATION |
| Please print clearly. Name:____________________________ Phone: (PM)___________________ Address:______________________________ (AM)___________________ ____________________________________ Zip:_____________________ Name of people attending with you. List full names and ages. 1.________________________Age___ 5.______________________Age____ 2.________________________Age___ 6.______________________Age____ 3._______________________Age___ 7.______________________Age____ 4._______________________Age___ 8.______________________Age____ Registration fee enclosed: $20.00 per person, Immediate family of 3 or more $50.00 Total: $___________ This is a non-refundable fee, which will help with the meal cost and better accommodate you. Make checks payable to: National Pike wagon Train Association Mode of transportation . Indicate with number. WAGON____ HORSE____ WALKING____ TOTAL NUMBER OF HORSES____ *Present Coggins and Health Papers, for each animal, at check-in. MUST BE CARRIED WITH YOU AS YOU TRAVEL. Mark days with number of persons eating each meal: WED. DINNER ______ THURS. B___ L___ D___ FRI. B___ L___ D___ SAT. B___ L___ D___ SUN. Brunch_____ Number of support vehicles: Car___ Truck___ Camper___ Trailer___ Van___ Other___ Number using shuttle bus: Thurs.____ Fri.____ Sat.____ . Do you or a member of your party have a current card for CPR?Yes___ No___ First Aid? Yes___ No___ Any other medical training, Please list _______________ ___________________________________________________________________ Are you willing to transport Girl Scouts (scouts have Girl Scout Insurance).Yes___ How many ___ If you have any questions call: Faye Augutine 724-437-6050 Ext.230. Thank you for your cooperation. Please forward registration to: National Pike Wagon Train Association c/o Faye Augustine, 695Main Street, Addison, Pa. 15411 WAVER The undersigned and registered group agrees to release and hold harmless the National Pike Wagon Train Association, its officers, sponsors, and scouts from any and all liabilities consequences therefrom, known or unknown, foreseen or unforeseen, arising out of or in any way connected with said event/trip. _______________________________________ (Signature) |
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