Inspiring. Meaningful. Adventure.
Wild, Wonderful Withlacoochee Trip January 18-23, 2018 Paddler #1: _____________________________________________________________________________________________________________ Name
Address
City
State
Zip Code
_____________________________________________________________________________________________________________ Email Home Phone Cell Phone on Trip Age T-Shirt Size _____________________________________________________________________________________________________________ Emergency Contact Name Emergency Contact Phone Does paddler #1 have medical training? MD
RN
EMT
PA
1st Aid
Other: _____________________________
Paddler #2: _____________________________________________________________________________________________________________ Name
Address
City
State
Zip Code
_____________________________________________________________________________________________________________ Email Home Phone Cell Phone on Trip Age T-Shirt Size _____________________________________________________________________________________________________________ Emergency Contact Name Emergency Contact Phone Does paddler #1 have medical training? MD
RN
EMT
PA
1st Aid
Other: _____________________________
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Paddle Club
Friend
Other: ________________________________________________________________ TRIP FEES: The full trip fee includes camping, meals, and shuttle.
Trip Fee $525 $500 $500 $475 Free
Paddler Category Adults Senior (65+) College Students Youth (8-17) Children (7 & under)
# of Paddlers
TOTAL:
Combined Fees $ $ $ $ $ $
Paddle Florida Lite $110/day. Can’t get away for the whole trip? Choose the Paddle Florida Lite option and pay a daily rate over four or fewer days. The daily fee includes a meal plan, but no shuttle. If you are not paddling the whole trip, you may need to arrange for your own shuttle transportation. Contact Bill Richards at
[email protected] for more information. Paddler #1 is choosing the Paddle Florida Lite option. Number of days: ______ x $110/day = $________ Paddler #2 is choosing the Paddle Florida Lite option. Number of days: ______ x $110/day = $________
TOTAL: $________ Please send your completed registration form and a check made payable to Paddle Florida for total fees th owed before the January 4 registration deadline to: Paddle Florida, PO Box 5953, Gainesville, FL 32627.