Paddle Bender 9K

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Team name   First name   Last name   Email address   Date of birth    MM 01 02 03 04 05 06 07 08 09 10 11 12    DD 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31    YYYY 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920    Gender -- Male Female   Distance Choose one 9K Men Masters 50+ 9K Men Open 9K Tandem 9K Women Masters 50+ 9K Women Open   Category Choose one Canoe Fast Sea Kayak High Performance Kayak OC1 Pedal kayak Prone Sea Kayak SUP < 12'6 SUP 12'6 SUP 14' Choose one Canoe Fast Sea Kayak High Performance Kayak OC1 Pedal kayak Prone Sea Kayak SUP < 12'6 SUP 12'6 SUP 14' Choose one Men's Mixed Women's Choose one Canoe Fast Sea Kayak High Performance Kayak OC1 Pedal kayak Prone Sea Kayak SUP < 12'6 SUP 12'6 SUP 14' Choose one Canoe Fast Sea Kayak High Performance Kayak OC1 Pedal kayak Prone Sea Kayak SUP < 12'6 SUP 12'6 SUP 14'   Event entry fee increases after April 30, 2019 Event entry fee TBD

Street Address  *   City  *   State  *   Zip  *   Phone number  *   Emergency contact name  *   Emergency contact phone #  *   For tandem list partner's name For tandem list partner's emergency contact name and number. Vessel/SUP length  *   Vessel/SUP Brand/Model  *   Vessel/SUP hull material  *   T-shirt size  * (Choose one) Medium Large X-Large   For tandem partner's T-shirt size None Medium Large X-Large Where did you hear about Paddle Bender? Received e-mail www.sepseries.org River Runner Referred by friend Carolina Wildlife Center Facebook past participant Other Additional donation to PAWS Animal Wildlife Sanctuary, Inc.?  * NoYes   USD

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