WWCC Membership Application

Full Name *

Your answer

Email *

Your answer

Address *

Your answer

Cellphone, please insert spaces, 027 123 4567 *

If no cellphone, use home phone

Your answer

Date Of Birth *

YYYY

Disabilities or medical conditions that may influence your safety on the river *

Answer "None" if applicable

Your answer

Kayaking Experience *

Your answer

Emergency Contact Name *

Your answer

Emergency Contact Phone, please insert spaces, 027 123 4567 *

Your answer

Membership Category *

Declaration *

I consent to the collection of the above details by the Whitewater Canoe Club 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 Whitewater Canoe Club (Inc.), I agree to abide by the club constitution.I acknowledge my right to access and correct this information.

Required

Signed *

Your answer

Date *

YYYY

Submit

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service

Forms