REGISTRATION: Please print and mail completed form for each person/boat.

After June 17, please call 319-752-1857 or 1-800-RIVER-12 with credit card and the below information.

YES, I WANT TO PADDLE the IOWA 2007

Name ___________________________________________Age ________

Address __________________________________________________

City, State, Zip______________________________________________

Phone (day)__________________________ (eve)___________________

E:mail (please print clearly)_________________________________________

second person:

Name ___________________________________________Age ________

Address __________________________________________________

City, State, Zip______________________________________________

Phone (day)__________________________ eve)___________________

E:mail (please print clearly)_________________________________________

Additional passenger(s) name _________________________________________ Age _____

Registration Fee (all fees include tax)

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

____# canoe rentals @ $32 ……………………………..…… $______

____# kayak rentals (call for prices)…………………………. $______

____# lunches @ $6 (sandwich, chips, fruit) ………………… $______

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

NON-REFUNDABLE. THE EVENT WILL BE HELD RAIN OR SHINE

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