PADDLE & A MOVIE REGISTRATION: Please print and bring completed form with you.
Please call or e:mail by Friday, Oct 18 so we know you are coming. Rentals require credit card to hold.

Name ___________________________________________Age ________

Address __________________________________________________

City, State, Zip_____________________________________phone____________________

E:mail (please print clearly)_________________________________________

second person:

Name ___________________________________________Age ________

Address __________________________________________________

City, State, Zip______________________________________phone_________________

E:mail (please print clearly)_________________________________________

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 _______________________

Signature _____________________________________________ Date _______________________

Registration Fee

____# participants @ $15……………………….…………… $____________

____# canoe rentals @ $50 (includes registration for 2 people)....$____________

____# kayak rentals (call to reserve) @ $35…………………... $____________

Total ..................................... .....................................................$____________

Checks should be made out to River Basin Canoe & Kayak and mailed to 13038 Hwy 61 North, Burlington, IA 52601. Advance registration is required. THANK YOU.