Name
Phone
Address
Email
City
State Zip
Birth Date Gender:
M F
T-Shirt Size (if available) S M
L XL
Name
Phone
Address
Email
City State
Zip
Birth Date Gender:
M F
T-Shirt Size (if available) S M
L XL
Division
Boat Make
Boat Dimensions
K1 Rec*
Sea Kayak*
K1 Unlimited
C1
C2
C2 Recreational*
Female (any boat)
Open (any boat not listed above)
Novice (any boat / 5-mile course)*
High School (any boat / 5-mile course)
I, the undersigned, certify that I agree to abide by the rules of the race (USCA) as well as the instructions and directives
of the race officials. I affirm that I will inspect the race course prior to the race and will not race if it is beyond my
capabilities as a paddler. I also agree to hold harmless from liability for injuries to my person or property, the sponsoring
organization, officials, landowners and the committee members and realize that it is not incumbant upon them to furnish first
aid, rescue, or salvage equipment and personnel.
Signiture of Paddler
Date
Parents Signiture if under 18 Date
Signiture of Paddler
Date
Parents Signiture if under 18
Date
Total Fees Paid $__________ Check Number
_____________
All donations will be forwarded to the American Lung
Association - Maine.
ALL PADDLERS MUST HAVE A LIFE JACKETS IN THEIR BOATS.
PADDLERS UNDER 18 MUST WEAR LIFE JACKETS.
