REGISTRATION FORM
				2017 Bill Gichner Memorial Hammer-In, hosted by the Mid Atlantic Smith’s Association
						Hutchison Brothers Farm, 11006 Lewistown Road, Cordova 21625
								January 6 - 8, 2016

The 2017 hammer-in will feature five special guests from Ukraine.  Sergiy Polubotko, Anatoliy Rudik, and Mykola Laptyuk will be the blacksmith demonstrators.
Mrs. Olga Polubotko will narrate Saturday’s presentation. Mrs. Svitlana Laptyuk will conduct a culinary demonstration showcasing traditional Ukrainian 
cooking, assisted by Mrs. Polubotku. Mr. Polubotko is dedicated to furthering the art of blacksmithing as an organizer of the International Blacksmith 
Festival Sviato Kovaliv in Ivano-Frankivsk. Mr. Rudick worked with MASA member Bruce Jarrell on a University of Maryland Baltimore Student Center project 
featured in ABANA’s Winter 2013 issue of The Anvil’s Ring. Mr. Rudick and Dr. Jarrell demonstrated at ABANA’s 2014 Dover conference.

Cost per person is $60. After December 23, 2016, the cost is $80 per person if room is available. 
Call David Hutchison for availability at 410-310-3347. 
Sunday only price is $20. Meals include coffee and donuts for breakfast Saturday and Sunday, Friday dinner, Saturday lunch and dinner and Sunday lunch. 
Please bring items for display and the auction, which will be held on Saturday after the demonstration and before dinner. 
There will be no Iron-in-the-Hat due to limited space.

People are welcome to arrive on Friday after 12pm. There will be a dinner on Friday at 6pm. After dinner the Mid-Atlantic Smith’s Association’s Annual 
Meeting held along with the Election of Officers. The Hammer-In continues all day Saturday starting at 9am and ends with a presentation after dinner. 
Sunday starts at 9am and continues until the afternoon.  

Fill out this form. Please make check payable to Mid-Atlantic Smith’s Association or MASA, and send it and the form to: 	
Patricia Harvey, 8341 Black Dog Alley, Easton, MD 21601-6329

Name ____________________________________________________________________________Phone ____________________________________

Address______________________________________________________________________________________________________________________

City ______________________________________________________________________ State _____________________Zip ____________________

Email Address ______________________________________________________________________________________________________________

Please list the names of other persons attending _______________________________________________________________________
	
	Cost per person $60, $80 after Dec. 23 x (number of people attending)	________   =   $___________		
	Sunday Only $20 x (number of people attending) 				________   =   $___________
	MASA Dues $10.00 per year						________   =   $___________
	Total Amount Enclosed							________   =   $ ___________

To help with meal planning, please indicate which meals you plan on having and the number of people for each. 
 
	Friday dinner		_______
	Sat. Breakfast  	_______
	Sat. Lunch 		_______
	Sat. Dinner 		_______
	Sun. Breakfast 		_______
	Sun. Lunch		_______
 

Mid-Atlantic Smiths’ Association (MASA) Liability Release Form
I, the undersigned, realizing the potential hazards involved in the craft of blacksmithing, will not hold the Mid-Atlantic Smiths’ Association, 
its officers, demonstrator(s), host(s) responsible for any accident or injury incurred during an association function or at any time during a 
sponsored MASA activity.

I am aware of the requirement to wear safety glasses during association demonstrations and of the possibility of hearing damage due to the 
nature of the craft. It will be my responsibility to inform any family member or guest that I may bring to a demonstration of potential dangers 
and advise them of all necessary precautions.

Signature: _____________________________________ Date: ___/____/______
Website - MASASMITHS.ORG		www.facebook.com/Mid-Atlantic-Smith-Association