Ladies White Water Rafting Trip Interest Form Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Cell Phone*Email* Emergency ContactName* First Last Phone*Please mark the appropriate boxes* Riding with someone Driving alone I will caravan from Church I am driving and taking the following people: Name of person(s) riding with you:First NameLast Name I understand the following* I understand the following* Please Call Pangaea directly at 1-877-239-2392 with credit card in hand, and mention Candlelight and Shani Ochsner or Brenda Van Noy for your discount. Also mention any food allergies or sensitivities when you call. Remember payment is due to Pangaea directly on or before July 9th Watch your email for a link to pay Pangaea and sign the online waiver form electronically. Payment is due by July 9th I understand I am not paying on the Candlelight website (with a credit card) and that I will pay directly to Pangaea with a credit card. If I am not paying by credit card, I will make arrangements before July 9th. I will indicate that in the comment box below and I will be contacted. Pangaea rafting trips are family friendly and that they take kids six and older on our whitewater trips. I am in reasonable good health and physically fit to go on a white water rafting trip. I understand any medical or health condition could endanger myself on the trip or anyone I bring on the trip. Pangaea requires a signed waiver for each participant. Comments: