| Name: | |
| Email Address: | |
| Street Address: | |
| City/State/Zip: | |
| Phone Number: | |
| Important – Please check one: |
New Memeber Renewal |
| What type of boating are you into? |
Kayaking Touring Rafting Other |
| Approximately Skill Level? |
Beginner-New Meat, err… “new paddler” |
| In what conditions do you paddle? | |
| Please provide any other information that would be beneficial: | |