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This is an explanation of the purpose of the form ...

  1. Please provide the following contact information:email address

    Name
    affiliation,[ club, Org]
    Street Address
    Address (cont.)
    City
    State/Province
    Zip/Postal Code
    Country
    Work Phone
    Home Phone
    E-mail
    URL

  2. Please provide the following
    Class or Trip information:

    Trip or Class
    Type Boat                  
    Location of Event  
    Date of Event
     
     

     

  3. BILLING
    Purchase Order #
    Account Name

  4. Please identify and describe yourself:

    Age
    Sex Male Female
    Height
    Weight

  5. Select any of the following options that apply:

    Medical Issues, Anything that I should be aware of for your safety and that of the Trip group
          Such things as allergies, etc.
          
    Equipment needed  generally for trips and skill classes we supply Boat, Paddle map Weather report  Water Report .
            For Instructor classes

         

  6. Enter todays Date

    -- mm/dd/yy

Antietam Creek Canoe
Copyright © 2003 [ACC]. All rights reserved.
Revised: 01/25/08