ALCATRAZ LIVING HISTORY DAY
REGISTRATION FORM
SATURDAY, OCTOBER 4, 2008
Please complete ONE Registration Form for EACH Participant (family of 4 = 4 forms)
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: ____________