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To register, please complete this form, print it out and then mail it, along with your check to the address below.

Name:

E-mail Address:

Phone:( ) -

Cell phone:( ) -

Street Address: 

City:

State (abbr):

Zip:

City of Entry: 

City of Exit:  

Please indicate shirt size for free shirt: 

Moisture Wicking T-shirt:             Short Sleeved
            Long Sleeved     Sleeveless

 

Second Registration:

Name:

E-mail Address:

Phone:( ) -

Cell phone:( ) -

Street Address: 

City:

State (abbr):

Zip:

City of Entry: 

City of Exit:  

Please indicate shirt size for free shirt: 

Moisture Wicking T-shirt:             Short Sleeved
            Long Sleeved     Sleeveless         

 

If your full week registration is received before July 15, 2012, you will receive a free shirt.  You can purchase additional moisture wicking shirts below.  The full week registration includes a ticket to the farewell banquet.

FEE CALCULATION:

Full Week: people x $125 ea
Shuttle –
    Lewis & Clark Visitors Center, IL to
Jefferson City, MO:
                        Shuttle people    x $25
                        Shuttle boats      x $25
Daily: people x $25 ea day x days
Canoe/kayak Rental  *(mark choice below)
                        $35 per day x days

Farewell party August 4 for daily paddlers and

            non-registered guests

            (Party is included in 7 day fee!!)

                         people x $15 ea

= $



= $
= $
= $

= $



= $

Sub Total Fee :  $

* Canoe / Kayak Rental ( Please indicate your choice):

 Tandem Canoe(2 people)     Solo Canoe(1 person)

 Tandem Kayak(2 people)     Solo Kayak(1 person)

Additional moisture wicking shirts may be purchased.  Please indicate quantity and size below:

            Short Sleeved:
small short sleeved x $20 ea
medium short sleeved x $20 ea
large short sleeved x $20 ea
extra large short sleeved x $20 ea
2XL short sleeved x $20 ea


= $
= $
= $
= $
= $

Total = $

            Long Sleeved:
small long sleeved x $20 ea
medium long sleeved x $20 ea
large long sleeved x $20 ea
extra large long sleeved x $20 ea
2XL long sleeved x $20 ea


= $
= $
= $
= $
= $

Total = $

 

            Sleeveless:
small sleeveless x $20 ea
medium sleeveless x $20 ea
large sleeveless x $20 ea
extra large sleeveless x $20 ea
2XL sleeveless x $20 ea


= $
= $
= $
= $
= $

Total = $

Total Fee :  $

For Day by Day paddlers, please check the days you wish to paddle:
( Saturday, July 28th, 2012 is the shuttle from Lewis & Clark Visitors Center, IL to Jefferson City, MO )

July 29, Jefferson City, MO to Bonnots Mill, MO (16 miles)
July 30, Bonnots Mill, MO to Chamois, MO ( 14 miles )
July 31, Chamois, MO to Hermann, MO ( 22 miles )
August 1, Hermann, MO to Washington, MO ( 30 miles )
August 2, Washington, MO to Klondike, MO ( 17 miles )
August 3, Klondike, MO to St. Charles, MO ( 28 miles )
August 4, St. Charles, MO to
                        Lewis & Clark Visitors Center, IL ( 29 miles )

To register, please print out and complete this form. Then, send your form and check to:
Great River Rumble, P.O. Box 3408, Dubuque, Iowa  52004-3408

If you have any questions, please call or write:

Snail mail: Great River Rumble, P.O. Box 3408, Dubuque, Iowa, 52004-3408

Or Call: Rex Klein (708) 747-1969