Captain Info

Name

* First Name

* Last Name

Address

* Street

* City

* State

* Zip

Group/Organization

* Org Name

* Org Relationship

Contact

* Phone

Secondary Phone

(optional)

* Email Address

* Emergency Contact Name

* Emergency Contact Phone

Crew Members

Member Names and Addresses

Must be at least 12 years old and wear a U.S. Coast Guard Approved life vest and closed toed shoes

Event Info

* Boat Name

* Boat Length (ft)

* Construction Material

Additional info

I agree to the Video/Photo/Audio Consent Release Terms and Conditions. *

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