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West Virginia Wildwater Association
Whitewater Kayak Clinic Registration

The deadline for registering (May 19, 2019) has passed.

Clinic Date: May 25-26, 2019  Location: Summit Lake Campground near Richwood WV  Registration Deadline: May 19, 2019

Complete this form & click on the "Next" button at the bottom for each student.

Clinic Payment Method
   Based on your Payment Method selection below, you will either see a page to pay online or a page with instructions for mailing in your check.
Clinic Fee = $60.00 per student (there is a $30 discount for WVWA and Team River Runner members)
I will pay   Online via Paypal       Check via Mail 
This registration is being submitted by:
First Name:  
Last Name:   
Email Address: 
Check here  if you are a WVWA member
Check here  if you are a member of Team River Runner
Student Information
   If the student's name and/or email address are left blank, the name and/or email address shown above will be used for the student.
First Name:   Last Name: 
Email: 
Age: 
If you're an ACA member, enter your ACA #: 
Address: 
(2nd line):  
City:    State:     Zip: 
   Telephone Numbers: (XXX-XXX-XXXX)
Cell:   Home: 
List any medical conditions that you have that should be known by your instructor: (This information will be kept confidential.)

Special requests or things your instructor should know: (Also include parent names if student is under 18-yrs-old.)

Additional Information
I would like to borrow a boat and/or any other gear? (select one)  Yes  No
   My height is:     and I weigh   pounds

I will bring my:   WW Kayak   WW Canoe   Other (specify) 

My current skill level:  Beginner (little or no whitewater experience)  Novice  Intermediate

How long have you been paddling?       I've paddled  times in the last 6 months.

What is the most difficult river that you feel comfortable paddling & at what river level? (If none - type "none".)

What is the most difficult river you have paddled in control & at what river level? (If none - type "none".)

Describe anything else about your current skill level & your goals for this clinic:

What do you want to do next? Choose one:
Save this registration and add another one         Save this registration and pay now

 

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