CANOE PICNIC Date14/07/18 Your Information First name Last name Phone Email Address Address Address 2 City/Town County - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle EastArmed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Postcode Age Booking for other people? Are you booking for other people as well as yourself? Other canoeists names and ages Other canoeists names and ages First name Last name Age Item weight more items Other information Is this your first Winding River Canoe experience? - Select -YesNo Do you, or anyone you are booking for, have any medical issues that might effect your ability to canoe? Please explain briefly Where food is provided on the trip please indicate any dietary needs (vegetarian, vegan, GF) Please explain briefly Photographs for publicity - Select -YesNo Are you happy for us to use photos we take on the trip to be used for our publicity? Have you read, and do you agree to our Terms and Conditions? Payment email If someone else is to be paying for your trip please enter the email address of their paypal account/the email address the paypal recipt will be sent to. This is to allow us to connect your booking to a payment in our system.