*First Name: *Last Name:

Group or Party Name (if applicable):

Address:
City: State: Zip Code:

*Telephone:
*Email Address:

*Select Trip Package: Package 1 Package 2 Package 3 Package 4 Package 5 Package 6

*How Many People In Your Group?: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 If More Than 15 People, How Many?

*Day You Want To Take Your Trip: ...

*Number of Canoes and/or Kayaks You Will Need.
(2 People per Canoe. 1 Person per Kayak)
Canoe(s) Yes No - How Many?
Kayak(s) Yes No - How Many?

How did you hear about Parkers Landing CK&O?
Friend
Radio
Outdoor Show
Internet
Newspaper
Other, Please Specify:

Any Additional Comments?