2017 Packraft Roundup Registration Form

Select the number of participants in your group (14 years and older) registering for the Roundup today: *

Are any participants in your party 13 years old or younger? *

Participant #1's Full Name *

First Name Last Name

Participant #1's Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Participant #1's E-mail *

Participant #1's Mobile Phone Number *

- Area Code Phone Number

If you are a member of the American Canoe Association, please enter your member number here:

Participant #1: Please rate your paddling ability...

Participant #1: Please indicate your packrafting experience...

Participant #2's Full Name *

First Name Last Name

Participant #2's E-mail *

Participant #2's Mobile Phone Number *

- Area Code Phone Number

If this person is a member of the American Canoe Association, please enter their member number here:

Please rate the paddling ability of Participant #2...

Please indicate the packrafting experience of Participant #2...

Participant #3's Full Name *

First Name Last Name

Participant #3's E-mail *

Participant #3's Mobile Phone Number *

- Area Code Phone Number

If this person is a member of the American Canoe Association, please enter their member number here:

Please rate the paddling ability of Participant #3...

Please indicate the packrafting experience of Participant #3...

Participant #4's Full Name *

First Name Last Name

Participant #4's E-mail *

Participant #4's Mobile Phone Number *

- Area Code Phone Number

If this person is a member of the American Canoe Association, please enter their member number here:

Please rate the paddling ability of Participant #4...

Please indicate the packrafting experience of Participant #4...

Participant #5's Full Name *

First Name Last Name

Participant #5's E-mail *

Participant #5's Mobile Phone Number *

- Area Code Phone Number

If this person is a member of the American Canoe Association, please enter their member number here:

Please rate the paddling ability of Participant #5...

Please indicate the packrafting experience of Participant #5...

Participant #6's Full Name *

First Name Last Name

Participant #6's E-mail *

Participant #6's Mobile Phone Number *

- Area Code Phone Number

If this person is a member of the American Canoe Association, please enter their member number here:

Please rate the paddling ability of Participant #6...

Please indicate the packrafting experience of Participant #6...

Please provide full names and ages of participants in your group under 14 years of age...as well as parental contact information if different from your own...

Number of motor vehicles that your party will be using to travel to the Roundup:

Type of vehicle(s) that your party will bring to the Roundup:

small car, station wagon, camper van, or pickup truck pull-behind camper trailer (no motor drive) large motorhome RV motorcycle

Select the Quantity of participants 14 years and older in your group... *

2017 Packraft Roundup $ 50.00

Quantity

(To register by mail, please provide the information requested on this form, and include it with a check for the above amount to American Packrafting Association, PO Box 13, Wilson, WY 83014. If you are paying by check, you do not need to click "Register.")