REGISTRATION: Please print and mail completed form for each person. Registration for classes can be printed out and mailed to our shop or you can call us and make your reservation. You may also save the form and e:mail to us. Please do not e:mail credit card info!! Please do not mail reservations if the class is less than a week away.

CLASS REGISTRATION **********Class name and date ______________________________

Name ___________________________________________Age ________

Address __________________________________________________

City, State, Zip______________________________________________

Phone (day)____________________ (eve)___________________(cell)__________________

E:mail (please print clearly)_________________________________________

___ I have my own boat

___ I'd like to use a River Basin boat for the class (all equipment is included)
...............approximate height and weight ________________________

I recognize that there is an element of risk in any outdoor activity. Knowing of the inherent risks, dangers and rigors, I certify that I and my family are fully capable of participating in this paddle trip. I assume full responsibility for my personal property and expenses while participating in this event. I agree to hold harless River Basin Canoe & Kayak. I also give River Basin Canoe & Kayak permission, without limitation, to use any photographs that might be take of me while participating in this event.

Signature ______________________________________________ Date _______________________

Registration Fee (all fees include tax) $64.20……………………….…………… $______

Total amount enclosed ...................................................$____________

To pay by credit card (card must have visa or mastercard symbol on it):

Name as it appears on card ________________________________________________________

Billing address___________________________________________________________________

Card number _____________________________________ expiration _____/_____security code______

NON-REFUNDABLE. THE EVENT WILL BE HELD RAIN OR SHINE.
We reserve the right to cancel in case of dangerous water conditions. If we cancel the class you will be refunded.

Mail check or money order and completed form to :
River Basin Canoe & Kayak
13038 Hwy 61 North
Burlington, IA 52601