2013 Boat Trip Form

Name(s)_______________________________________________

              _______________________________________________

Address ____________________________________________

               ____________________________________________

               ____________________________________________

Email (print clearly) ________________________________________________________

 1st Cell Phone (        ) - _______ - __________

2nd Cell Phone (        ) - _______ - __________

Home         (         ) - _______ - __________

"Please double check phone numbers and email in case there is a change in plan."

How did you hear about the trips? ___ email  ___ website ___FKRLF member

                                                         ___ Lighthouse Digest  ___ USLHS ___ other _______________

Make check payable to FKRLF and mail to FKRLF, c/o Eric S. Martin, 1067 Drift Creek Cove,

Orlando, FL, 32828