I (print name)________________________________ do hereby release from any and all liability the
Illiana Historical Association and  _________________________ for any and all injuries to myself or any
damage or loss to my property which may occur while I am in the activities or events of the Illiana Historical Association
on the dates of _______________________

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____________________________________Date______________________

Authorization of Emergency Medical Care
I (print name)________________________________ do hereby authorize the Illiana Historical Association ,______________________, or their agents to authorize emergency medical treatment on my behalf
in the event that I should  injure or suffer any medical distress while participating in this event. It is understood that
this is not a transfer of liability or responsibilityto the Illiana Historical Association, 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 _____________

In Case of  an Emergency please Contact:
Emergency contact: ______________________   Phone #_____/______/__________

PLEASE NOTE ANY UNUSUAL MEDICAL CONDITIONS BELOW.__________________________
__________________________________________________________________________

(Please Print Only)
Organization:_______________________Unit: __________________________________ 
Complete Address: _____________________________________________________
Telephone # : __________________E-Mail:  ___________________________________
Are you bringing Class 3 Weapons:_____________Yes/No___________
Would you like to bring any military vehicles:_____Yes/No___________

 PRE-REGISTRATION FEES                                          (Preregistration is mandatory!) 
                                                     Please Check Selection
___ Public Event (Free)
___ Tactical Event $20  (per person)-includes Battle fee & camping
Overnight accommodations:   Yes   _____     No  _____   
      
$________ TOTAL ENCLOSED
Make your check/money order payable to the Illiana Historical Association
DO NOT SEND CASH! MAIL THIS FORM AND YOUR CHECK/MONEY ORDER TO:
               Illiana Historical Association, PO Box 294, Griffith, IN 46319