"Sixth
Corps to Gettysburg"
2013
Memorial March Registration
Last Name ___________________________________ First/Middle________________________________
Address __________________________________________City ___________________ State ____ Zip ______
Phone H: __________________________ W: __________________ Cell (optional): _____________________
E-mail Address ____________________________________________________ (for registration confirmation)
Emergency Information Date of Birth ___/_____/____ Medical Problems ____________________________________________________
__________________________________________________________________________________________
In Case of Emergency Notify ___________________________________Relationship ______________________
At Phone Number: Day: ________________________________ Night: ___________________________________
We will ask each participant to provide proof of medical coverage or assumption of liability.
Your desired participation level
A. Days and distances (Check the box next to your selection)
Day One - June 26 -
Ox Hill to Dranesville
(approx. 15 miles)Day Two - June 27 -
Dranesville to Edwards Ferry
(approx. 15 miles)Day Three - June 28 -
Edwards Ferry to Hyattstown
(approx. 17 miles)Day Four - June 29 -
Hyattstown to Taylorsville
(approx. 22miles)Day Five - June 30 -
Taylorville to Manchester
(approx. 17 miles)Day Six - July 1 -
Day of rest near ManchesterDay Seven - July 1 (10:30PM) & July 2 - Manchester to Little Round Top (approx. 37 miles) B. ___ I will be in period Union military uniform, appropriate to June, 1863.
C. ___ I will be in modern clothing.
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and current information is available at www.dougdobbs.com. Please read that info and if you have further questions, contact Doug Dobbs at doug@dougdobbs.com or C: (717) 816-2941. After June 25 I will most likely not check email messages, call the cell number. |
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| Please print & complete
this form and bring it with you.
Be aware
that space is limited to 35 participants on any given day.
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