Saturday June 3, 2017 Sponsored by the Susquehanna River Trail Association

Great River Adventure

FAMILY PADDLE Registration Form ● One Registration Form is required for EACH canoe/kayak boat team Maximum of two adults and two youth under age 14, per boat ● A signed Waiver Form is required for EACH individual, including youth ● Registration Fee: $10 per person, no charge for youth under age 14 as of 6/3/17 Current 2017 SRTA members should take a $5 discount Fees Paid: $ ________ (check payable to: SRTA) Participants receive: Pre-Race Hot Drinks/Donuts Safety Boat Service I.D. Placard for Participating Boat

2017 SRTA Membership SRTA Trail Guide ( 1 per Boat ) GRA Event T Shirt

Post Race Picnic Lunch Drawing Ticket Bus Shuttle Service

Water Snack Fun for All

PLEASE PRINT ALL INFORMATION LEGIBLY Paddler: ______________________________________ Age as of 6/3/17 (if youth boater) _____ T shirt size ______ Street: ______________________________________ City: ____________________ State: ____ Zip: ________ Phone: ______________________________________ Email: _______________________  2017 SRTA Member Partner 1: ______________________________________ Age as of 6/3/17 (if youth boater) _____ T shirt size ______ Street: ______________________________________ City: ____________________ State: ____ Zip: ________ Phone: ______________________________________ Email: _______________________  2017 SRTA Member Partner 2: ______________________________________ Age as of 6/3/17 (if youth boater) _____ T shirt size ______ Street: ______________________________________ City: ____________________ State: ____ Zip: ________ Phone: ______________________________________ Email: _______________________  2017 SRTA Member Partner 3: ______________________________________ Age as of 6/3/17 (if youth boater) _____ T shirt size ______ Street: ______________________________________ City: ____________________ State: ____ Zip: ________ Phone: ______________________________________ Email: _______________________  2017 SRTA Member ● For the discount, mail Registration Forms, Waivers, and checks no later than Monday, May 29 to: SRTA PO Box 62023 Harrisburg PA 17106-2023 Otherwise bring the registration and waiver forms along with you on Saturday, June 3 ● See Registration Form to arrange for renting any needed equipment ● Questions: Email: [email protected] Web: www.susquehannarivertrail.org Day of Event: Trip Leader Brook Lenker: [email protected] Cell: 717-756-2637 Event Coordinator: John Meister W: 717-697-2261 H: 717-766-2214 or [email protected] REGISTRAR’S USE ONLY  ALL fees received

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Cash/check #________

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ALL waiver(s) received

NOTES:

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Boat I.D. # placard given

T Shirt Sizes:

Boat I.D. # ________

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Lunch Voucher Given

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Given

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Needed

Directed to Boat I.D. # drawing stub box Directed to snack, water & premium table