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    Please fill out this form and press submit to
    email your information to the Alaska Kayak School.

     

    Name:
    Street Address:
    City:       State:      Zip Code: 
    Phone # Work: Home:
    Email:  
    Age:   Weight:   Height:
    Occupation:  
    Course Title:  
    Course Date(s):  
    Mode of Payment: Mail check  
    Send credit card to Kayak School
    Skill Level:  
    Describe your swimming ability:
    None, Poor, Good, Excellent
    Specify shoe size (men's equivalent)
    Tell us about your regular physical activites and outdoor background:
    What do you hope to achieve from this course?:
    List small boat experience, if any:
    Is there anything else you would like us to know? Health condictions, etc.?
    If you would like to pay for your course online please fill in credit card info below:

    Credit Card No.
    Expiration Date
    Name on Card
       

     
    (907) 235 - 2090
    Homer, AK

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