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Please Provide the Following Information
First Name

Last Name

Street Address
Address (cont.)
City

   Province/State

Zip/Postal Code

   Country

Home Phone   
 Work Phone
E-mail
Trip Destination

Course Title  

Trip Date

 Course Date

Indicate your canoeing/sea kayaking experience:

Never Novice Intermediate Pro

Indicate your camping experience:

Never

Campground Camping

Wilderness < 10 Nights Wilderness > 10 Nights

List any food, medical, plant, or insect allergies that you have:

Do you have any physical limitations that may hinder your ability to paddle a canoe or carry loaded packs across portage trails?

Indicate all the beverages you enjoy drinking:

Coffee 

Hot Chocolate 

                Tea