Backus 1812 Registration Form
Re-enactor and Sutler Registration Form - Please complete the form below to register for Backus 1812 on Saturday, September 9 and Sunday, September 10, 2017.

Setup Times: encampments may be set-up no sooner than 9:00am on Friday, September 8, 2017. Take-down may commence at 4:00pm on Sunday, September 10, 2017.

CONTACT
FIRST NAME
Your answer
LAST NAME
Your answer
CITY/TOWN
Your answer
ADDRESS
Your answer
PROVINCE/STATE
Your answer
POSTAL CODE
Your answer
PHONE NUMBER
Your answer
EMAIL
Your answer
INFORMATION
UNIT OR SUTLERY NAME
Your answer
UNIT COMMANDER NAME
Your answer
INSURANCE COMPANY
Your answer
POLICY NUMBER
Your answer
ROLE
MY ROLE
PLEASE LIST THE NAMES, AGES AND ROLES OF OTHERS IN YOUR FAMILY/SUTLERY:
Please list the names, ages (for those under 18) and roles of ALL participants in your family/sutlery. Note: individual waivers must be signed upon arrival at event by everyone 18+. Parents or guardians must sign for participants under 18 years of age.
Your answer
ARTILLERY
ARE YOU BRINGING ARTILLERY?
IF YES, WHAT TYPE, SIZE AND QUANTITY?
Your answer
ACCOMMODATIONS
WHAT WILL YOU BRING?
No modern camping is permitted in Backus Heritage Village. No pets in period camp. Please contact backus1812@lprca.on.ca for any special arrangements.
PLEASE PROVIDE THE NUMBER & TENTS FOR EACH TYPE LISTED ABOVE:
Your answer
IF YOU ARE A SUTLER, PLEASE SPECIFY PRODUCTS/WARES TO BE SOLD. ADVANCE REGISTRATION IS REQUIRED TO SET-UP IN SUTLERS ROW:
Your answer
IF YOU ARE DAYTRIPPING, PLEASE SPECIFY WHAT DAYS YOU WILL BE HERE FOR:
DO YOU HAVE SPECIAL NEEDS OR CONCERNS?
Your answer
RELEASE
PRIVACY
We value your privacy. Your email address will only be used by the Long Point Region Conservation Authority to communicate with you regarding the regarding the RE-ENACTMENT EVENT. We will not share your personal information or email address without your permission. Following the War of 1812 event, do you give Long Point Region Conservation Authority permission to send you information regarding future programs and events?
QUESTIONS?
Thank you for registering for Backus 1812. Should a question arise after submitting your registration you may contact:

Sheila Johnson
Backus Heritage Conservation Area
1267 Second Concession Rd
Port Rowan, Ontario N0E 1M0
519.586.2201 ext 228
backus1812@lprca.on.ca

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