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  

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

Pilot:   SMART#:

Copilot:   SMART#:

Home:   Pilot's Mobile:   Copilot's Mobile:

Pilot's Email:

Street

City     State     Zip

In Case of Emergency (ICE) Contact Information

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

Notify:   Phone:   Relationship:

Notify:   Phone:   Relationship:

RV Information

RV Type:         Make:

Model:         Length:

I tow a vehicle behind my motor home.   Total length of tow and towing vehicles:

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.”

Planned Arrival:       Planned Departure:

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.

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.