SUP ICW (24-26May2019)

Please complete the below form to register for the ICW on 24-26 May 2019. Mandatory fields are marked with an asterisk (*).

ACA Member Number

Last Name

First Name

Address

City

State

Zip (5 digit)

Phone

(###)

###

####

Email Address

Birthdate

MM

DD

YYYY

Do you have all required equipment?

Do you own or have access to an appropriate boat, paddle, PFD, helmet, and safety equipment?

Yes

No (Contact Mike to coordinate)

Add me to CKAPCO's e-mail list?

Yes

No

Upgrade or update?

Upgrade

Update