Great Rivers Rendezvous Registration EmailThis field is for validation purposes and should be left unchanged.This field is hidden when viewing the formNext Steps: Install the User Registration Add-OnThis form requires the Gravity Forms User Registration Add-On. Important: Delete this tip before you publish the form.Name(Required) First Last Participant Age(Required)Email(Required) Cell Phone(Required)Address(Required) Street Address City State / Province / Region ZIP / Postal Code Emergency Contact Name(Required)Emergency Contact Phone(Required)Watercraft(Required) Personal Kayak (12.5 feet or longer) Personal Canoe (12 feet or longer) Personal Paddleboard (10 feet or longer) Rental from MRWTA A US Coast Guard Certified Life Jacket is required to be worn at all times on the water by ALL participants. If you don't own a properly fitted life jacket we will provide one for you to borrow. Please indicate size.(Required) Youth Adult (S/M) Adult (M/L) Adult (L/XL) Adult (2X) I’m bringing my personal USCG approved life jacket Other YouthAdult (S/M)Adult (M/L)Adult (L/XL)Adult (2X)Bringing my own USCG approved jacketPaddle Distance(Required) Piasa Harbor (7-mile) Hideaway Harbor (12-mile) Great Rivers (2-Day, Overnight) Member Type(Required)Current ACA MemberNon-ACA ParticipantACA Number(Required)Boat Rental Single Boat Double Boat Shuttle Bus Yes No (I will take care of my own shuttle) Total Credit Card Cardholder Name Card Details Δ