2015 Registration Form

Murraylands Regional Tourist Association
PO Box 344, Murray Bridge, SA 5253
ABN: 25 339 324 252
Ph: 0448 533 147
[email protected]
www.floatfest.com.au
www.visitmurraylands.com
www.facebook.com/FloatfestAus
2015 Registration Form
You can have as many people in your canoe or kayak as per the Australian manufactures standard rating.
Please refer to your canoe or kayak to check before the event.
Paddling into the Record Books – Guinness World Record Attempt
We beat the SA record last year, join us to beat it again for 2015!
Mannum – Mary-Ann Reserve & Mannum Waters - 2nd & 3rd May 2015
Record attempt @ Mannum Waters Sunday Morning.
*Participants will be expected to attend Saturday 2nd or May 3rd to the Registration Desk to collect
the ID Number of your Registration and sign an ASSUMPTION OF RISK FORM (no one will be allowed
into the water without signing this form).
*Safety information will be in Registration bags.
* Bring your Life Jackets with you.
REGISTER before the event on May 3rd, 2015 and go into the draw to WIN a Cruise for two on the
PS Murray Princess!
rd
Winner will be drawn 3 May, 2015 at 2pm Mary Ann Reserve, Mannum at the Bank SA Marquee.
NAME:
(Mr/Mrs/Miss/Ms)
STREET ADDRESS:
SUBURB:
POSTCODE:
TELEPHONE: (H)
(M)
EMAIL:
AGE:
If under 16 years a Parental Guardian is required to sign the back of this
form.
1. Canoeing skill level:
Beginner / Intermediate / Advanced (Please circle applicable)
2. Swimming Skills:
Cannot swim / Beginner / Moderate / Strong
3. Will you need to hire a kayak/canoe?
No
Yes
4. Are you attending Floatfest as part of a group?
No
Yes
Group Name:
Number of craft:
(Please note: Groups will be invoiced separately).
How did you hear about Floatfest? __________________________________________________________
5. Do you have any medical conditions or disabilities?
If yes, please specify:
No
Yes
6. Do you take any prescribed medications in relation to the above condition?
No
Yes
Please list:
7. Emergency contact details:
Name
Relationship
Contact Number
8. I have read the Safety Guidelines from Canoe Australia:
9. Payment is included with signed Registration Form:
No
No
Yes
Yes
Pricing
$16.50 (GST inclusive)
Please Circle the method of payment
Cheque | Money Order | Direct Deposit
Cheque Payments:
To be sent to Murraylands Regional Tourist Association Inc.
PO Box 344, Murray Bridge, SA, 5253.
Direct Deposit:
MRTA, Bank SA, BSB: 105-085, Acc: 030 490 540
Reference: Surname on this form.
Amount paid:
Date of Payment:
/
/
Once payment has been made please post this form to:
Murraylands Regional Tourist Association Inc., PO Box 344, Murray Bridge, SA, 5253.
I have carefully read and agree to the terms and conditions of entry into this event.
Signed:
Date:
/
/
Signed by parent or guardian (if entrant is under 16 years of age). You will be required to sign an
Assumption or Risk form at the Floatfest Registration desk on the day of record attempt.
Signed:
Date:
/
/