Contact information

First name

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Last name

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Phone

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Phone type
Email address

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Address

Address

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Apartment, suite, etc. (optional)
City

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Country/region

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State

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ZIP code

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Additional details

One registration per family! Please list the total number of children attending under your registration name:

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Please list the age of each child:

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It is manadatory to wear a life jacket in order to participate! If your child needs to borrow a life jacket, please list the size(s) needed. If none, please write "none".

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Registration fee

A registration fee is required to participate

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Payment

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Card number
Cardholder name

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Account holder name

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Billing address

Address

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Apartment, suite, etc. (optional)
City

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Country/region

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State

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ZIP code

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