Rich Mountain

INSTRUCTIONS - PLEASE READ CAREFULLY

Welcome to Rich Mountain. Members of both Mess #1 and the Rich Mountain Battlefield Foundation thank you for your support. We look forward to seeing you in July. Please fill out all fields in this registration form. All registrations are to be done individually, so a SEPARATE REGISTRATION MUST BE SUBMITTED FOR EACH INDIVIDUAL REGISTRANT.

The registration process will only be completed after you have sent in payment. You name will not be listed on the roster until payment has been received. We will be posting a roster of those who have registered for the event on a regular basis from the time the first registration are received until the registration deadline, so check back frequently to make sure yours was received.

Last Name:

First Name:

Your Age:

(Must be 16 to Carry a Rifle.)

If Under 18:

Name of Person Responsible For You at the Event.

Street:

City:

State:

Zip Code:

Your E-mail:

Impression:

Your Home Unit:

(if no unit affiliation, write “independent”)

Are You a Driver For the Event?

With Whom Are: You Traveling?

How Man Hours are You Driving ?

From Where Are You Driving?

Emergency Contact Name:

Emergency Contact Number:

Blood Type:

Do You Have Any Allergies/Medical Conditions?

Do you have medication with you?
Important: If you are a certified EMT or have lifesaving/first aid training and would be willing to help our medical staff at this event, please mark "yes" to the right and we will contact you prior to the event.

Registration Fees: The registration fee is $20.00 per person. Underage participants must be registered by a parent or guardian who must sign the release form on their behalf. If you are sending a check, it should be made out to “Rich Mountain Battlefield Foundation” and sent to:

Rich Mountain Battlefield Foundation
c/o Ken Cornett
5600 Lakeview Drive
Mason, Ohio 45040

liability Release and Agreement
to Abide by the Rich Mountain Standards:

I, the undersigned, understand that I will be participating in a potentially dangerous activity on July 14-16, 2006 (“the 2006 Rich Mountain Semi-Immersion Event “RM”), with the use of firearms and the recreational use of the Rich Mountain property for outdoor activities. As a condition to, and in consideration for receiving permission to participate, I hereby agree and promise to assume risk and responsibility for any and all injuries, or damages due to injuries, suffered by me or caused by third parties to me, arising out of participation in the aforementioned activities. I hereby release, indemnify, forever discharge, and hold harmless, members and guests of Mess #1 and the Rich Mountain Battlefield Foundation and the event’s participating organizations from any and all responsibility, liability, claims for personal injury, legal actions or suits, damages, or losses of any kind or description, both at law or in equity, arising out of, or in any way connected with, any of the above-mentioned activities. I have read and will comply with the RM standards. I understand that my gear is subject to inspection at any time during the event. I understand that I will respect and honor the orders of officers and non-commissioned officers appointed over me. If I have misrepresented my impression I may be asked to leave the event.

I have read and accept the terms for the Rich Mountain Event.