LONG DISTANCE CANOE AND KAYAK REGISTRATION

LONG DISTANCE KAYAK PARTICIPANT DETAILS
CATEGORY
NAME OF PARTICIPANT

First NameLast Name
AGE OF PARTICIPANT
HAS THIS PARTICIPANT SUBMITTED AN ONLINE WAIVER? If "No", please submit a waiver
Go to SUBMISSION DETAILS on Page 3 to complete your registration

SUBMISSION DETAILS
NAME OF PERSON SUBMITTING REGISTRATION

First NameLast Name
EMAIL
example@example.com
PHONE NUMBER to receive text messages
Please enter a valid phone number.Format: (000) 000-0000.
DATE SUBMITTED

MonthDayYear
Date
Should be Empty: