Walnut Mountain Park, Liberty New York
Registration Form
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Unit _____________________________________________________ Company ________ US ______________ CS______________
Infantry __________ Cavalry __________Mounted Cav._________ Artillery___________________Civilian ________
Company Comander ( rank) __________________________________ Contact Person ________________________
Unit's Address ______________________________________________ Email _________________________________________
Phone Number w/ area code ______________________________ Affiliation_________________________________
(I, the undersigned, understand that this re-enactment involves inherent dangers and is renowned for being physically demanding. I have read the rules and regs and agree to abide by those standards for this event.
I have sufficiently conditioned myself for this event and I agree to indemnify and hold harmless the Walnut Mountain Civil War Weekend Committee, The 143rd N.Y.V.I., its executors, County,Village,Town Officials,
and all Volunteers as a result of any personal loss,accident,injury,harm or claim that may arise. Also, because of their position of competent authority in the hobby, I will unquestionably obey all the officers' and NCOs' orders.
I further agree to abide by any decisions made by the sponsors on matters that are not covered.
Please Print Sign in at Event Site
1._________________________________________ 1.__________________________________________________
2._________________________________________ 2.__________________________________________________
3._________________________________________ 3.__________________________________________________
4._________________________________________ 4.__________________________________________________
5._________________________________________ 5.__________________________________________________
6._________________________________________ 6.__________________________________________________
7._________________________________________ 7.__________________________________________________
8._________________________________________ 8.__________________________________________________
9._________________________________________ 9.__________________________________________________
10.________________________________________ 10.__________________________________________________
{If more space is needed, please use back of form}
Please include $10.00 per participant ( Military and Civilian ) when you return this form.Your registration fee will include Live Entertainment. Children under 12 need to be registered but do not require and application fee.
Send check to 143rd NYVI, 1049 Oregon Tpke Honesdale, PA 18431