PADDLE & COOK OUT OCTOBER 16, 2010 REGISTRATION:
For registration after October 11 please call 319-752-1857 with credit card.
Phone and e:mail registrations will require credit card payment.

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 harmless River Basin Canoe & Kayak. I also give River Basin Canoe & Kayak permission, without limitation, to use any photographs that might be taken of me while participating in this event.

Signature ______________________________________________ Date _______________________

Registration Fee

____# participants @ $20……………………….…………… ..$____________

____# canoe rentals @ $25.........................................................$___________

____# kayak rentals (call to reserve)............…………………... $___________

____# non paddlers - cook out only @ $5...................................$___________

Total ..................................... .....................................................$___________Please add 7% tax

We reserve the right to cancel the trip in case of dangerous water conditions. If we cancel the trip you will be refunded.

Mail check or money order and completed form to:
River Basin Canoe & Kayak
13038 Hwy 61 North
Burlington, IA 52601
If you prefer to pay by credit card and e:mail us the registration, please call with your card info. Do not e:mail it!