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 *

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 *

I consent to the collection of the above details by the Canterbury Whitewater Club (Inc.) for the purpose of club membership records and course enrolment; and for the club to retain, use and disclose these to the national association, funding agencies and sponsors. If accepted as a member of the Canterbury Whitewater Club (Inc.), I agree to abide by the club constitution. I acknowledge my right to access and correct this information.

Required

Signed *

Date *

YYYY

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