WMass Mobilization for SEPT. 24
DC BUS INFO
WE'RE READY TO ROLL: S24 BUS INFO [Please forward
widely.]
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=========================
The Western Mass. September 24 DC Mobilization is
ready to begin selling bus
tickets, which will be mailed upon receipt of
payment. Departure times and
locations TBA.
For more information, phone 413-587-0059
(Northampton), or email
wmassmobe@hotmail.com
* Ticket cost: $65 per seat
* Make checks or money orders payable to
"Western Mass. Mobilization" and
mail them to WMass Mobe, Post Office Box 2733,
Springfield, MA 01101. Please
make certain your name, mailing address and phone
number appear on your
check or money order; if it doesn't, please be
sure to provide this
information. If you are purchasing more than one
ticket, please include
names and contact information of others
travelling with you. NB: No
electronic forms of payment (Pay Pal, etc.) can
be processed; please do not
send cash.
* Those younger than 18 years of age should be
accompanied by a parent,
legal guardian or other adult. If applicable,
please sign and send the
consent form below with payment. (Our thanks to
Atty. Charles Jenks of
Traprock for developing this document.)
Supervision of Minors, Waiver of Liability and
Certification by Parent or Legal Guardian
for the WMass September 24 DC Mobilization
Persons under 18 years of age must be accompanied
by a parent or legal
guardian. Such parent or guardian must accompany
the person under 18 on the
round trip bus ride and must supervise the person
under 18 during any bus
stops and while they are in Washington, D.C.
I, _________________________________, certify
that I am eighteen years of
age or older, and I am the parent or legal
guardian of
______________________________, (person), who is
under the age of 18,
residing at
_____________________________________________________________and
take full responsibility for this personŐs safety. I will accompany this
person on the bus for the round trip between
Massachusetts and Washington,
DC, and I will supervise this person during the
entire trip, including the
bus ride, any stops, and time spent in
Washington, DC, including the march
and rallies.
I agree to indemnify, hold harmless and defend
all organizers of this trip
from any liability for negligence arising out of
this trip, including the
time spent on the bus, any stops, and the time
spent in Washington, DC.
I will make certain that the person is on the bus
after any stops and for
the return trip from Washington, DC. If the
person is not on the bus, and
time has arrived for the bus to leave, I shall
stay in the locale and take
full responsibility for finding the person and
ensuring the personŐs safety.
Under no circumstances may I hold any said
organizers liable for leaving
without myself and the person on board, and I
agree to indemnify, hold
harmless and defend all said organizers from any
liability that may arise
out of their leaving on the bus without the
person and myself on board.
I hereby certify under the pains and penalties of
perjury that all facts
recited above are true and I hereby agree to all
provisions set forth above,
as a necessary condition of myself and my child
or ward participating on
this round trip to Washington, DC for the march
and rallies on September 24.
Signed this ___________ day of _____________,
2005 by
_________________________________
Name
_________________________________ ______________________________________
Street Address, with any apt. number, City or
Town,
STATE, zip code
_________________ ________________, _________________________________
Telephone Number(s) email if available
Name, Address and Phone number of emergency
contacts:
1. ________________________________Phones
(____)_________ , (____)
__________________________________
2. ________________________________Phones
(____)_________ , (____)
__________________________________
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ALL OUT FOR SEPT. 24 IN DC!
