Start Date: 2025-12-11       Departure Date: 2025-12-14

Poverty Point Reservoir State Park

• Address: 1500 Poverty Point Parkway, Delhi, LA 71232
• Phone: (833) 609-0686
• For Reservations Contact: Campground

Sponsor(s): Cajuns

Host: Kathy Letsinger     Phone: (318) 366-8816     Email: Jkletsinger@gmail.com

Muster Costs:

Single Cost: $20.00   Couple Cost: $40.00   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 $20.00.00   Two Persons $40.00.00   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

Tours

  Tour#1 Laying Wreaths for Wreaths Across Americ - Cost: $0.00

We will participate in the worldwide effort of laying wreaths on veterans’ graves at the National Veterans’ Cemetery in Rayville, LA   Total: $

  Tour#2 Poverty Point World Heritage Site Tram T - Cost: $0.00

An entertaining and educational tour by State Park ranger.   Total: $

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 Cajuns), to Bo deBlieux, 10161 Hillsbury Drive, Baton Rouge, LA 70809.