Registration Form

Course	select Beginner Classes #1- Cost: $105 Beginner Classes #2- Cost: $105 Beginner Classes #3- Cost: $105 River Running Concepts Lesson- 4 Hrs. Cost: $120 Strokes and Concepts Lesson-2 Hrs. Cost: $60 Get to Know Your Potomac’ Lesson-5 Hrs. Cost: $150 Play the River Lesson-4 Hrs. Cost: $120 Pool Rolling Class single lesson $40 Know Your Roll Lesson-4 Hrs. Cost: $120 Risk Management and River Safety Lesson 6 Hrs. Cost: $150 Intermediate class 3 lessons package $199
Date of class
Name
Street Address
City
State/Province		Zip
Work Phone
Home Phone
Cell Phone
E-mail
Date of Birth
Height
Date
Sex	Male Female
Weight	approx
After submitting your request classes will be checked to see if space is available. Upon confirmation you will recieve a bill via e-mail for the entire amount. Class confirmation will not be complete until payment is recieved in full. All registration must be completed 48 hours ahead of class time. Payments must be recieved 24 hours before class date. If you have any questions please contact Jim Buley at 301-840-7388. Thank You !