IMPORTANT—Each participant must provide a signed liability release (permission slip) form. Roster, release forms, and payment are due by **Monday, February 28, 2005**. The forms should be e-mailed to:

Maggy E. - maggieeddy-at-earthlink.net

Troop/Crew No.:	_____________________________________________________
Primary Contact Person:	_____________________________________________________
Preferred Email Address:	_____________________________________________________
Telephone (DAY):	_____________________________________________________
Telephone (EVENING):	_____________________________________________________
Telephone (CELL):	_____________________________________________________
Secondary Contact Person:	_____________________________________________________
Preferred Email Address:	_____________________________________________________
Telephone (DAY):	_____________________________________________________
Telephone (EVENING):	_____________________________________________________
Telephone (CELL):	_____________________________________________________

Hiker Names and Estimated Distances (use an additional sheet if necessary)

Name	Age	Distance goal (miles)
__________________________________________________	_______	___________________
__________________________________________________	_______	___________________
__________________________________________________	_______	___________________
__________________________________________________	_______	___________________
__________________________________________________	_______	___________________
__________________________________________________	_______	___________________
__________________________________________________	_______	___________________
__________________________________________________	_______	___________________
__________________________________________________	_______	___________________
__________________________________________________	_______	___________________

Support Adults’ Names and Preferred Time Frames (use an additional sheet if necessary)

Name	Time Frame
__________________________________________________	_______
__________________________________________________	_______
__________________________________________________	_______
__________________________________________________	_______
__________________________________________________	_______
__________________________________________________	_______

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23 February 2005