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Virginia Living Museum
Bennett's Creek Canoe Registration
March 20, 2010

Time: 7:00am-7pm
Age: 18+ (9-17 with an adult)
Cost: $40 Members; $60 Non-Members


 

 

I am a VLM Member

Members: Please complete the section below.
Non-Members: Please continue to next section to register.
Total Adults: If more than 3, please submit another registration
1st Adult Name:
2nd Adult Name:
3rd Adult Name:

Total Children If more than 4, please submit another registration 
1st Child Name:  
DOB if under 18:

2nd Child Name:
DOB if under 18:

3rd Child Name:
DOB if under 18:

4th Child Name:
DOB if under 18:

Non-Members: Please complete the section below.
Members: Please continue to previous section to register.

I am NOT a VLM Member
Total Adults: If more than 3, please submit another registration
1st Attendee Name:
2nd Attendee Name:
DOB if under 18:
3rd Attendee Name:
DOB if under 18:


*Address:
*City:
*State:
*Zip:
*Daytime Phone:
*E-mail Address:
Do any registrants have medical conditions?
If yes, please list registrant and condition:
Special requests or comments:

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