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: / /