CWWC Membership Application
If you’re interested in whitewater, you are welcome to join the club! Members who wish to
participate on club river trips take responsibility for communicating their level of paddling
prowess, aspire to develop their river safety skills and be a good person on and off the river.
First Name *
Last Name *
Email *
Street Address *
Suburb *
City *
Postcode *
Cellphone, please insert spaces, 027 123 4567 *
If no cellphone, use home phone
Date Of Birth *
MM
/
DD
/
YYYY
Disabilities or medical conditions that may influence your safety on the river *
Answer "None" if applicable
Kayaking Experience *
Emergency Contact Name *
Emergency Contact Relationship to You *
Emergency Contact Phone, please insert spaces, 027 123 4567 *
Membership Category *
Declaration *
Required
Signed *
Date *
MM
/
DD
/
YYYY
Submit
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