This Form and Payment MUST BE RECEIVED by March 28, 2016

Finger Lakes Trail Conference 2016 Cross-County Hike Series Registration Name(s): _______________________________________ ___________________________________________________ Mailing Address: ___________________________________________ City: ___________________________ State: _____ Email: _____________________________________

(preferred way to communicate with you?) Yes_______No_____

Home Phone: ___________________________

Cell Phone: _____________________________________

Emergency Contact (friend or relative not hiking with you): _______________________Telephone: ________________________ Check Anticipated Hiking Speed: __Fast __ Medium-Fast __ Medium __ Medium-Slow __ Slow __ Half Hike Half Hikes will be in a one speed group that will vary between Medium, Medium-Slow, and Slow • • •

Cost per Member registrant: $50 per Adult, $35 per child under 18 with an adult. Registration$________ Cost for Non-Member registrant: $90 per Adult, $35 per child under 18 with an adult. Registration$________ I am not an FLTC member, but would like to join at a discounted rate of $30 (individual) or $40 (family) (membership through 3/31/17) (New members only; not to be used for renewals) Membership $________

Pre-order* Merchandise (tax included) Maps $________

•

I would like ____set(s) of 5 FLT Maps (M1-M5) for this hike series ($13.00)

•

T-Shirt Member Pricing: X-Small ($16) ___ Small ($16)___ Medium ($16) ___ Large ($16)___ XL ($16)___ 2XL ($18)___ 3XL ($19) ___ T-Shirt $________ T-Shirt Non-Member Pricing: X-Small ($21)___ Small ($21)___ Medium ($21)___ Large ($21)___ XL ($21)___ 2XL ($22)___ 3XL ($23) T-Shirt $________ Pullover Member Pricing: Small ($42)___ Medium ($42)___ Large ($42)___ XL ($42)____ 2XL ($45.00)___ 3XL ($48) ___ Pullover $ ________ Pullover Non-Member Pricing: Small ($46)___ Medium ($46)___ Large ($46)___ XL ($46)____ 2XL ($48.00)___ 3XL ($51) ___ Pullover $ ________

• • •

Pre-Order Your Hike T-Shirt (cool and dry) and/or Sport-Wick Stretch Pullover (tax included)

Total Amount Enclosed: $ ________ *Maps, T-Shirts and Pullovers will be delivered at the beginning of the hike.

Back of T-Shirt reads “2016 Cattaraugus County Hike”

This Form and Payment MUST BE RECEIVED by March 28, 2016

Please Read and Sign the Following Waiver: Those persons enjoying the Finger Lakes Trail (FLT) and/or activities sponsored by the Finger Lakes Trail Conference (FLTC) or any clubs conducting activities on behalf of, or in support of the FLTC, accept full, personal responsibility for their own well-being, or, for the well-being of a minor when acting in the capacity of parent or guardian. Furthermore, users of the Finger Lakes Trail accept and understand that hiking is a rigorous activity often conducted in rugged, outdoor conditions subject to variations in weather and terrain that may involve the risk of injury or death, and that they are fully responsible for their own safety and for selecting activities consistent with their physical capabilities. Print Name _______________________________ Signature __________________________________ Date___________ Print Name_______________________________ Signature __________________________________ Date___________

Please Read and Sign the Following Photo Release Form: I, ______________________________________ hereby grant the Finger Lakes Trail Conference (FLTC) permission to use my name and/or likeness taken in any photograph or digital media in any of its promotions, publications, press releases, brochures, website or social media entries without payment or any other consideration for the following: ( ) Today Only ( ) The Event/Series: ______________________________________________ ( ) Until Further Notice I understand and agree that any photograph or digital images are the property of the FLTC and hereby irrevocably authorize the FLTC to edit, publish, or distribute these for purposes of promoting or publicizing the Finger Lakes Trail. I waive the right to inspect or approve the finished product, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to use of these images. I hereby hold harmless and release and forever discharge the FLTC from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization. I am 21 years of age or older and am competent to contract in my own name. I have read this release before signing below and I fully understand the contents, meaning, and impact of this release. If the person signing is under age 21, there must be consent by a parent or guardian. ________________________________________________________________ __________________________ Signature

Date

I hereby certify that I am the parent or guardian of __________________________________, named above, and do hereby give my consent without reservation to the foregoing on behalf of this person. _________________________________________________________________ ___________________________ (Parent/Guardian’s Signature)

Date

__________________________________________________________________ (Parent/Guardian’s Name Printed)

Mail this form with your Check or Money Order made payable to Finger Lakes Trail Conference, Inc., 6111 Visitor Center Road, Mount Morris, NY 14510 (Also see our website http://fingerlakestrail.org/trail/crosscounty for online registration through PayPal.)

This Form and Payment MUST BE RECEIVED by March 28, 2016