River Rat Paddle Challenge 2019

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Who are you registering? Choose one Yourself Someone else Team

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 Female/Male   Name of Your "Rat Pack" Choose one #GOTSTRONG Bayou Voodoo Paddlers Better Late Than Never Chicks With Yaks CO Cruiser Fire Breathing Rubber Duckies Gator Bait Geauxbeaut H2Go Paddle J. Krewe de Bayou Lafayette Paddle Club Memphis Mafia Merchants Of Grains Monday Night Kayak Sprints Rats Of The Blue Moon Roe City Kayaks Shake, Rattle And Paddle Smokey and the Bandit Sowashee Paddle League Team H2Go Team Red White and Blue Team Red, White, and Blue The Kids Are Alright The Otters Twin City Outdoor Yak Crew Tye Dyed Vikings Unknown Yaksquatch Other     Team Member Name (> one person/craft) Other     Phone #   Address   Emergency contact name   Emergency phone #   Category Choose one Big Boat C1 Race C1 Rec C2 Race C2 Rec K1 Fast K1 Long K1 Medium K1 Pedal K1 Pool Toy K1 Race K1 Short K2 Pedal K2 Race K2 Rec K2 Tandem Pedal SUP Inflatable SUP Race SUP Surf SUP Tandem   Event entry fee 50.00 USD

T-shirt size. You must register two weeks in advance to be guaranteed a shirt. None Small Medium Large Extra large XX Large Email address  *   Do you have current insurance with the American Canoe Association?  * NoYes   5.00 USD Would you like to purchase a raffle ticket for a chance to win a Sundolphin Journey 10ss kayak donated by Tractor Supply Co of Ruston? NoYes 5.00 USD ***If you are traveling to this event from out-of-town, please answer the following questions in order to fulfill our Monroe-West Monroe Convention and Visitor Bureau marketing grant requirements. Are you traveling 90 or more miles to this event? Yes No If yes, will you be staying overnight? Yes No If yes, where will you be staying? Hotel Friends or Family Other If staying overnight at a hotel, B&B, or campground, which one? How many in your party?

Total -- Calculate

Please review the waiver provided by the event organizer and click the check box below to accept it. Print waiver ADULT WAIVER MINOR WAIVER I accept the terms of the waiver Name of parent or guardian who approves this activity Please enter your name here