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Name: |
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Address: |
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City: |
Prov./State: |
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Postal/Zip Code: |
eMail: |
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Tel: Home |
Tel: Work |
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Program Selected: |
Program Date: |
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Canoeing or X-C skiing experience (as applicable): |
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Swimming Ability (canoeing programs): |
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Medical conditions or allergies: |
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Physical limitations (re: paddling/portaging): |
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Life Vest size (S, M, L, XL) |
Height (to size paddles): |
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Emergency contact person: |
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Tel: Home |
Tel: Work |
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Deposit enclosed: $ |
or Full Payment: $ |
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I accept the terms and conditions outlined under Booking Conditions. |
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Signature: |
Date: |
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