Mangroves, Manatees and More! (February 9-15, 2025)
Check Payment Form
Paddler Information
This information is required for each paddler on this trip
Paddler 1
*
First Name
Last Name
Meal Options
*
Traditional Meal
Vegetarian
Vegan
T-Shirt Size
*
Please Select
S
M
L
XL
XXL
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Medical Training
*
MD
RN
EMT
PA
1st Aid
Other
Emergency Contact
*
First Name
Last Name
Emergency Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Has this paddler had their Covid-19 Vaccination(s)?
*
Yes
No
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Next
Additional Paddler Information
Hit "next" if there are no more additional paddlers for this trip
Paddler 2
First Name
Last Name
Meal Options
Traditional Meal
Vegetarian
Vegan
T-Shirt Size
Please Select
S
M
L
XL
XXL
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Medical Training
MD
RN
EMT
PA
1st Aid
Other
Emergency Contact
First Name
Last Name
Emergency Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
Has this paddler had their Covid-19 Vaccination(s)?
Yes
No
Back
Next
Additional Paddler Information
Hit "next" if there are no more additional paddlers for this trip
Paddler 3
First Name
Last Name
Meal Options
Traditional Meal
Vegetarian
Vegan
T-Shirt Size
Please Select
S
M
L
XL
XXL
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Medical Training
MD
RN
EMT
PA
1st Aid
Other
Emergency Contact
First Name
Last Name
Emergency Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
Has this paddler had their Covid-19 Vaccination(s)?
Yes
No
Back
Next
Additional Paddler Information
Hit "next" if there are no more additional paddlers for this trip
Paddler 4
First Name
Last Name
Meal Options
Traditional Meal
Vegetarian
Vegan
T-Shirt Size
Please Select
S
M
L
XL
XXL
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Medical Training
MD
RN
EMT
PA
1st Aid
Other
Emergency Contact
First Name
Last Name
Emergency Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
Has this paddler had their Covid-19 Vaccination(s)?
Yes
No
Back
Next
Payment Information
Trip Options
*
Full Trip: $650
Full Trip (Senior, 65+): $625
Total paddlers registering on this trip
*
Trip Total
Mail In Check Amount
Mail-In Check Directions
Please mail in your check for the "Trip Total" amount to: Paddle Florida Inc PO Box 840205 St Augustine FL 32080
How did you hear about Paddle Florida?
*
Please Select
Happy Paddler
Newsletter
PF Website
Paddle CLub
FPTA Website
Brochure
Facebook
Other
If other, please specify
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