MAIL THIS FORM TO:

FOCWA

6009 Canvasback Lane

Citrus Heights CA 95621

Name:             _______________________

Address:        _______________________

                        _______________________

Email:             _______________________

Cell Phone:    ________________

Other Phone: ________________

Date of Birth: ________________

(Minors must have signature of Parent or

Guardian, below)

Emergency Contact

Name:             _______________________

Relationship:  _______________________

Cell Phone:    ________________

Other Phone: ________________

Impression:    _______________________

(Artillery, Secessionist, Civilian Cook, Fed Prisoner, etc.)

Military Unit:   _______________________

                        (Unit you be portraying, if applicable)

Will you be the driver of a car that is parking at Fort Mason?

(circle one)     YES                NO

Will you be utilizing the National Park Service shuttle from
Fort Mason to the Alcatraz Cruises Dock?

(circle one)     YES                NO

Signature:      _______________________

Signature of Participant

Print:               _______________________

Date:               ____________

Signature:      _______________________

Signature of Parent or Guardian

Print:               _______________________

Date:               ____________