Registration $400 for SCRA Members and $450 for Non-members Register for the 2019 Paddle Namekagon! Step 1 of 3 33% Name* First Last Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Email* Enter Email Confirm Email Phone Number*Is this your first time on the SCRA Paddle?*YesNoHow did you hear about the SCRA Paddle?*NewspaperWord of MouthSocial MediaNewspaperSCRA Email NewsletterBrochureOtherVessel TypeKayak (Recommended)CanoeDon't know yetFor shuttle planning purposes, please indicate the type of vessel you will be bringing.T-Shirt SizeSmallMediumLargeX-Large2X-LargeYour registration includes a custom 2019 paddle t-shirt. Release and WaiverParticipants must sign a Release and Waiver form to participate in paddles sponsored by the St. Croix River Association. BY SIGNING THIS RELEASE AND WAIVER YOU ARE GIVING UP RIGHTS TO SUE OR BRING A CAUSE OF ACTION AGAINST THE ST. CROIX RIVER ASSOCIATION AND/OR ANY OF THE PARTIES IDENTIFIED BELOW. Assumption of Risk: This paragraph says that you know the activity is dangerous, and that you take responsibility for your own safety. I agree and understand that participation in the SCRA Paddle will include activities which take place out-of-doors, possibly inclement weather, physical labor, use of watercraft and equipment, potential exposure to tick-borne and water-borne diseases, walking over rough terrain or in water, and being on or near an inherently dangerous body of water (the “Event”). I agree and understand that while my health and safety is the first priority of SCRA, the Event is not without risk. I agree that it is my sole responsibility to be familiar with the waters and grounds and any applicable laws and regulations for this Event, as well as any special rules. I understand and agree that situations may arise during the Event which may be beyond the immediate control of the organizers and I must continually act so as to neither endanger myself or others. I understand my participation in this Event may be terminated by event organizers if I fail to comply with any requirements. I accept responsibility for the condition and adequacy of equipment used. I have no physical or mental condition which to my knowledge would endanger myself or others if I participate in the Event, or would interfere with my ability to participate in this Event. I represent that I have health insurance that will cover any expenses relating to any injury that may happen connected with this Event. I agree to assume all risk of injury or harm to myself in the Event. Release, Waiver of Liability, and Indemnity: This paragraph says you agree no one will sue us if you get hurt. I hereby waive, release, and discharge for myself, my heirs, executors, administrators, legal representatives, assigns, and successors in interest any and all rights and claims which I have or which may hereafter accrue to me against the St. Croix River Association, sponsors, activity organizers, and their agents, employees, volunteers, participants, principals, directors, officers, organizers, guides, and any other participants (parties identified) through or by which the Event will be held for any and all damages, including, but not limited to, death or paralysis, which may be sustained by me directly or indirectly in connection with or arising out of my participation in or association with the Event or travel to or from the Event. I agree to defend and indemnify the St. Croix River Association and all parties identified above against any and all claims related to my participation in the Activities. EXCEPT, HOWEVER, I retain rights and claims based on reckless conduct or intentional harm. Medical Treatment: This paragraph says you agree to medical treatment if you’re so hurt you can’t respond. In the event of injury or illness while under the supervision of SCRA, I consent (if unable to provide or deny it myself) to receive first aid and/or any medical attention that may be needed as determined by, and at the discretion of, SCRA staff, emergency medical services, and licensed medical professionals. Photographic Release: This paragraph says we own and can use any photos and videos of you taken while you’re participating in the Paddle. I grant the SCRA and activity partners the right to use and reproduce any and all photographs and video images taken of me while participating in the Event (including but not limited to websites, newsletters, press releases, advertising, displays, etc.) without compensation. I understand and agree that all photographic materials, together with the prints and any video materials, shall be SCRA’s and SCRA-authorized groups' property. I further release SCRA and SCRA-authorized groups from liability and proprietary rights I may have in connection with such reproduction or use. Other: This agreement, release, and waiver is made in Minnesota, and any controversy arising out of my participation shall be heard in District Court of Ramsey County and be decided pursuant to the laws of the State of Minnesota. This agreement may not be modified orally, and a waiver or consent to any provision shall not be construed as a modification of any other provisions herein. Each clause of this Release and Waiver is severable from the other clauses, and a decision that one clause is unenforceable will have no effect on the enforceability of any other clause. BY SIGNING THIS RELEASE AND WAIVER I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND THE CONSEQUENCES OF SIGNING THIS DOCUMENT. THIS IS A COMPLETE ASSUMPTION OF RISK, AND A RELEASE AND WAIVER OF POTENTIAL CLAIMS.Waiver*I acknowledge that I have read and understand the consequences of signing this waiver.Signature of Participant*I am at least 18 years of age*Yes, I am 18 or olderNo, I am under 18PARENT OR GUARDIAN of minors: I, as parent or guardian of the above-named minor, personally assume any and all risks of my child’s or ward’s participation in the event. Furthermore, I give my permission for my child or ward to participate in the event, and further agree, individually and on behalf of my child or ward, to all of the terms and conditions stated above. I ALSO AGREE TO DEFEND AND INDEMNIFY THE ST. CROIX RIVER ASSOCIATION AND ALL OF THE PARTIES IDENTIFIED ABOVE AGAINST ANY AND ALL CLAIMS MADE ON BEHALF OF ANY CHILD OR WARD OF MINE.Name of Parent or Guardian First Last Signature of Parent or GuardianEmergency Contact InformationEmergency Contact* First Last Please give the name of someone we can contact in case of emergency.Emergency Contact Phone*Please provide the phone number of your emergency contact.Emergency Contact Email* Enter Email Confirm Email Please provide the email address of your emergency contact. Payment InformationAdditional PaddlersFirst NameLast NameEmailT-Shirt SizeVessel Type Please list any other paddlers included with this registration. Cost is per person.SCRA Member Cost per person Price: $400.00 Quantity: Non-Member Cost per person Price: $450.00 Quantity: Total $0.00 This is the total amount that will be charged to your credit card. Please verify that it is correct.Credit Card* American ExpressDiscoverMasterCardVisa Card Number Expiration Date Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Security Code Cardholder Name NameThis field is for validation purposes and should be left unchanged.