Mail completed form to: Fulton County Historical Society, Inc., 37 E 375 N, Rochester, IN 46975
Phone 574-223-4436 Mon. - Sat. 9 to 5, closed holidays.
Museum: Website www.fultoncountyhistory.org & email:
PTDA: Website www.potawatomi-tda.org & email Phone 574-223-2352.
Adults (except husband/wife) must fill out separate forms -- BOTH husband & wife & all adults must sign liability waiver.
1. Name ______________________________________________________________________
C.B. Radio nickname _____________________________________________________________
Those accompanying me: __________________________________________________________
City, State, Zip __________________________________________________________________
Phone _________-_________-____________, Cell Phone _________-_________-___________
Website _______________________________________________________________________2. Vehicle I will be driving on caravan:
Circle: Car or truck; Kind: ______________________ Color _______________ Year: _________
3. Insurance required. I and my vehicle are fully insured. Yes No
4. Riding with someone else - you still must sign Liability Waiver and fill in application.
5. I plan to arrive at Fulton County Museum: date & time ______________________________
6. I will attend the Trail of Courage Living History Festival Sept. 20-21. Cost $7 adults. Or you can work for FCHS a four-hour shift and earn free admission: Indian dancer ____ ; PTDA booth ____; Speaker _________; FCHS food booth ____; host in museum or historic building _____; other _______________________________
7. Volunteer to give presentation (history talk, traditional craft demonstration, or music) to school groups on Friday Sept. 20: I alone ___ My group (name) ______________________________________
8. NO DOGS or other animals allowed except those assisting handicapped.
9. I give my permission for FCHS to use any pictures of me and my outfit and camp at the Trail of Courage and/or on the Trail of Death Commemorative Caravan on the FCHS web page or to be published in newspapers and newsletters.
10. Liability Waiver: I waive and release the Fulton County Historical Society and its Potawatomi Trail of Death Assn., its agents, representatives, officers, committees and members from any and all claims or rights to damages for injuries or losses suffered by myself and/or members of my family, directly or indirectly while participating in the Trail of Courage Living History Festival and all its activities, including the Trail of Death Commemorative Caravan. I alone am liable for loss, damage, or injury to myself and my property and damage to others and their property by me, my property, family and pets while participating in the Trail of Courage Living History Festival and the Trail of Death Commemorative Caravan.
Signature ________________________________________________ Date _________________
Spouses signature _________________________________________ Date _________________
This must be dated to be a legal signature!
I enclose the following:
___ My check for $20 per person or $30 per couple made payable to PTDA, Fulton Co. Hist. Soc., Rochester, IN 46975.
___ I also want to join the FCHS Potawatomi Trail of Death Assn. and receive the newsletters, which will include the Trail of Death Commemorative Caravan news & pictures afterward, cost $20 year. Add to above and enclose check.
___ Self-addressed long (4 x 9 1/2) envelope stamped with 65 cents for reply. We send a lot of material and it wont fit in a little envelope! All registrants will receive a written reply on or before Sept. 15.
___ Photo of myself & others accompanying me in historic regalia (if possible).
I want the Trail of Courage to grow and be successful so:
In case of Emergency, while on the caravan, please notify:
City, State, Zip _________________________________________________________________
Phone _________-_________-___________, Cell Phone _________-_________-___________
___ I am an EMT, nurse, doctor or other medical person & willing to help in case of emergency.
___ I have a CB radio. Note: a CB radio is necessary on the caravan to communicate with the leaders and the group, get directions and history, find your way back to the caravan if you get separated, etc. Basic CB radios are about $50 at Walmart or Radio Shack.