Florida Keys Challenge
Credit/Debit Payment Form
*To avoid processing fees you can pay via check registration
Paddler Information
This information is required for each paddler on this trip
Paddler 1
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First Name
Last Name
Meal Options
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Traditional Meal
Vegetarian - No Meat of Any Kind
Vegan - Plant-Based Diet
Email
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example@example.com
Phone Number
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Please enter a valid phone number.
Address
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Street Address
Street Address Line 2
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State / Province
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Medical Training
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MD
RN
EMT
PA
1st Aid
Other
Emergency Contact
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First Name
Last Name
Emergency Contact Number
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Please enter a valid phone number.
Has this paddler had their Covid-19 Vaccination(s)?
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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 - No Meat of Any Kind
Vegan - Plant-Based Diet
Email
example@example.com
Phone Number
Please enter a valid phone number.
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.
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 - No Meat of Any Kind
Vegan - Plant-Based Diet
Email
example@example.com
Phone Number
Please enter a valid phone number.
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.
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 - No Meat of Any Kind
Vegan - Plant-Based Diet
Email
example@example.com
Phone Number
Please enter a valid phone number.
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.
Has this paddler had their Covid-19 Vaccination(s)?
Yes
No
Back
Next
Payment Information
Trip Options
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Flat Fee - Full Trip
$
1,100.00
Quantity
Full Trip (Seniors, 65+)
$
1,075.00
Quantity
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