*FirstName:                                                                        *LastName:
     

*Email:                                                 Phone Number:                   Cell Phone:
            

Address:                                               Zip Code                           City:                                  State:
                      Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachisetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgina Washington West Virgina Wisconsin Wyoming

Boat Name:                                        Boat Brand:                         Length:                      Desired Slip #
              

	Arrival	Departure	# of	Rate	Ext
	Date Day	Date Day	Days	$
Madison in Bloom	SAT	SUN
Madison in Bloom	SAT	SUN
Cam River Run Car Show	SAT	SUN
Regatta*	THUR	SUN
Ribberfest**	FRI	SUN
Chautauqua**	FRI	SUN
Soup, Stew, Chili & Brew	SAT	SUN
Other
Tax:
Total:

* Regatta: 3-night minimum

** Ribberfest & Chautauqua: 2-night minimum

Credit Card:	Number:	3-Digit Code	Exparation Date:
Visa Master Card American Express			January 01 February 02 March 03 April 04 May 05 June 06 July 07 August 08 September 09 October 10 November 11 December 12 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Name on Card:

Slip Rates Season Rate Daily Regular April 15- Oct 15 Holiday Regular Week Month F Dock $750 $40 $30 $190 $500 30' Uncovered $850 $60 $50 $310 $800 40' Uncovered $1,300 $70 $60 $380 $1,000 50' Uncovered $1,650 $90 $80 $500 $1,300 40' Covered $2,500 $90 $80 $500 $1,300 50' Covered $3,500 $110 $100 $630 $1,700