2010 NAMA-ENDORSED

CAMP SEQUANOTA FORAY WEEKEND

October 8, 2010 October 10, 2010

REGISTRATION

Number of Participants: (Adults, and 11 plus)_________ (Children under 11) ___________

NAME(S)_________________________________________________________________________

__________________________________________________________________________________________________

ADDRESS: (INCLUDING CITY, STATE, ZIP), TELEPHONE, E-MAIL: __________________________________________________________________________________________________

__________________________________________________________________________________________________

Please mark your attendance preference:

___ Full participation, Single occupancy ____ @ 175.00 ____________

___ Full participation, Double occupancy ____ @ 135.00 ____________

___ Full participation for a child 3 to 10 ____ @ 46.50 ____________

Full participation includes two nights lodging, linen service, 6 meals from Friday supper through Sunday lunch. Price for children assumes theyre sharing a room with their parents. If all spaces (40-45) in the Bowersox Enrichment Center become fully booked, space in somewhat rustic cabins may be made available at up to 44 less for the weekend. However, because there is a minimum charge of 95 per night for the cabins, which would require about 7 adults to cover, we would prefer to avoid using the cabins, which are a five to ten-minute walk from the Enrichment Center.

SATURDAY ONLY (3 meals, forays, programs)

____ Number of adult participants @ 48.25 _____________

____ Number of children 3 to 10 @ 10.75 _____________

All adult participants must be members of MAW, WPMC, or NAMA. Please specify your membership(s): __________________

Volunteer options: We expect all participants to be at least available and willing to help with some of the chores associated with an event of this nature. Please choose at least one possibility for each registrant.

Mycophagy/culinary prep or cooking - _________________________

Mushroom ID and display - ______________________________________________________

Cleanup (dining tables, or display tables at end of foray) - ______________________________

Wild mushroom donation (fresh or preserved from home, definitely identifiable - _____________

Foray leader - ________________________________________________________________

DIETARY RESTRICTIONS, e.g., allergies or specific type of vegetarian ____________________

TO AVOID A LATE FEE, REGISTRATIONS MUST BE RECEIVED BY SEPTEMBER 3, 2010

If registering after that date, please add 15 per person to your total amount.

Complete this form, sign the RELEASE (by all adult registrants), and mail with your check or money order made out to MAW (Sequanota 2010), to:Connie Durnan, Sequanota Registrar, 4509 Windom Place, N.W., Washington, DC 20016.

LIABILITY RELEASE AND PROMISE NOT TO SUE

I understand there is some risk in participating in a mushroom foray: all those risks one assumes by being away from home, risks associated with moving about in fields and woods, risks involved in eating wild mushrooms, risks of losing personal property by theft or misplacement, and all other expected and unexpected risks. In registering for or attending this foray, I agree to assume total responsibility during this event for my own safety and well-being, and that of any minor children under my care, and for the protection of my and their personal property. I release the Mycological Association of Washington, Inc. (MAW), the Western Pennsylvania Mushroom Club (WPMC), and the North American Mycological Association (NAMA), their trustees, officers, employees, contractors, and all other persons assisting in the planning and presentation of this event from liability for any sickness, injury, or loss I or any minor children under my care may suffer during this event or as a result of attending and participating. I further promise not to file a lawsuit or make a claim against any of the persons listed above, even if they negligently cause me or my minor children injury or loss.

Finally, I agree to hold MAW, WPMC, and NAMA harmless from any liability they may incur as a result of any damages to any property I may cause. This release and promise is part of the consideration I give in order to attend this event. I understand it affects my legal rights. I intend it to apply not only to me but to anyone who may have the right to make a claim on my behalf.

Signature 1 __________________________ Printed name _______________________ Date ____________

Signature 2 __________________________ Printed name _______________________ Date ____________

Signature 3 __________________________ Printed name _______________________ Date ____________