2024 FL Sunshine Christmas Muster Registration Form

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Start Date: 2024-12-09       Departure Date: 2024-12-13

Okefonokee Pastimes Cabins & Campground

  • Address: 28244 Ga Hwy 121, Folkston, GA 31537
  • Phone: (912) 496-4472
  • For Reservations Contact: Campground

Sponsor(s): FL Sunshine

Host: Peter Kerner     Phone: (912) 674-9740     Email: peter3801@netscape.net


Muster Costs:

Single Cost: $15.00   Couple Cost: $30.00   Couple + Guest Cost: $0.00  

Registration

An entry in all fields shown in the registration form is required.

Pilot:   SMART#:

Copilot:   SMART#:

   

Pilot's Email:

       

In Case of Emergency (ICE) Contact Information

Please provide at least one emergency contact other than your Copilot.

   

   

RV Information

       

       

I tow a vehicle behind my motor home.  

Attendees:   One Person $15.00.00   Two Persons $30.00.00   Two plus Guest $0.00.00

I (We) are first time attendee(s).

Guest Name:   Enter guest first and last names or “None.”

     

Handicap Parking         30 Amps   50 Amps

Do you or your traveling companion use any of the following, cane, walker, electric wheel chair, scooter, C-PAP?  

If Yes, please indicate which one(s):

Special Diet Needs  

His:  

Hers:

  I will volunteer to help at the Muster

Liability Release

In consideration for my (our) attendance, I (We) hereby release and agree to indemnify and hold harmless SMART, its officers, directors, employees, agents, successors, and assigns from any and all liabilities, claims, losses, and/or damages arising from my (our) attendance at this event.

All attendees must read and sign this form.

Name Signature Date
Pilot:
Copilot:
Guest:

Total Submitted: $_____________________

Please mail a copy of this form along with your check, (payable to Peter Kerner), to Peter Kerner, 207 Mallard Point Drive, Woodbine, GA 31569.