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Office and Reservation Staff Only!

Name *
Name
Permanent Address *
Permanent Address
This is where we'll mail your tax forms in January.
Summer Address *
Summer Address
Arrival Date *
Arrival Date
Birth Date *
Birth Date
Cell Number *
Cell Number
-last 5 years.
Emergency Contact Address *
Emergency Contact Address
Emergency Contact Home Phone *
Emergency Contact Home Phone
Emergency Contact Cell Phone *
Emergency Contact Cell Phone
In case of emergency, I authorize Sunny Cove Sea Kayaking and CIRI Alaska Tourism to release the above medical information to medical personnel. *
Signed *
Signed
Signature Date *
Signature Date