Paddle Race Registration Form
 

First Name: 

Last Name: 

Gender: 

Male Female

Age:

Address: 

City: 

State: 

Zip: 

Phone: 

 

Board: 

Board Size (In feet & inches): 

T-Shirt Size: 

Are you a Surfrider Member? 

Emergency Contact Name and Phone: 

Email: 

 

 
Comments:

 

 

  
 

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Security Code:  

 

 
 

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