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On-Line Registration for Catfish Round Up Saturday September 18, 2010 8:00 a.m. -1:00 p.m. Pete Peterson Lodge Lagoon Park

Please complete one registration form per participant Enroll in Catfish Round Up by completing this form.  Through the efforts of volunteers from the National Wild Turkey Federation we hope the adventures and challenges that you will experience will provide knowledge and memories to last a lifetime.

Group/Organization Name (If applicable):
Participant Name:
Address:
City, State, Zip:
Phone:
Cell Phone:
Email Address:
Age:
Sex:
Emergency contact name:
Relation to you:
Emergency phone number:
	Day or Night

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	In order to accommodate your needs and to ensure that you have a successful time at this event, we will need the following information.  Provide as much detail as needed.
	What is your disability (if you have a spinal cord injury, please indicate what level)?
	Do you require the use of assistive devices? If so, please list (manual wheelchair, power wheelchair, walker, prosthesis, etc.)
	Please list any allergies that we need to be aware of (food, latex, etc.)
	In our attempt to ensure that everyone has a great time, please tell us how many people will be accompanying you
	Is this your first time participating in Catfish Roundup?  Yes No
	Are you a veteran? Yes No
	Is this the first time you have attended a Wheelin' Sportsmen event? Yes No
	By checking this box, I hereby waive and release all other participants, the host, sponsors and all other officials or parties involved in the event from all claims and/or damage incurred in connection with this event. I acknowledge that this program involves some risk and I assume responsibility for the participant's actions and for any injury that may result from participation and also waive and release all other participants, the host, sponsors, guides, landowners, volunteers, instructors, the National Wild Turkey Federation, officials, and/or other parties involved in the event from all claims and/or damage/injury incurred in connection with this event. In addition, participant grants the sponsors, co-sponsors, and the National Wild Turkey Federation the unconditional right to use the name, voice, and photographic likeness of the person listed above, in regards to any of the publications and audio/video productions.