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Sam Fowlkes
ACA Safety and Rescue Committee Chair
347 Paddlers Trail
347 Paddlers Trail
Sylva, NC  28779
T. 828 586-6563
F. 828 586-9649
336-202-5531
whitewatersam@gmail.com
www.whitewater-rescue.com
Course Registration Form
Essential information!
 
 
Request Form
 Enter your information below.
Which course are you registering for?
Are you a current ACA member? yes
no
What is your ACA #? (if you are a member)
What type of craft do you paddle? canoe
kayak
inflatable
other
List any paddlesport training you have had in the last 10 years
Descibe your current level of paddling skills, (Class 1- 2-3-4-5), rivers paddled recently,ETC!
How would you describe your whitewater swimming skills?
Please describe your CPR/First Aid training + level of current certifications.
Please describe your goals for this course.
Payment information (50% deposit required for reservations) please make payable to Sam Fowlkes
Please mail check to SFC 347 Paddlers Trail Sylva,NC 28779
Please mail medical info form and ACA waiver to same! Medical information form
ACA Waiver and Consent form
Please give us a daytime and evening phone #
Name:
Street:
City:
State:   Zip
Email:


 

 
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