Centurion Canoe Club
Membership Form for the period Jan 2019 - Dec 2019
Centurion Canoe Club (CCC) Membership Type *
Are you a new or renewing CCC Member? *
How many boat racks do you want to rent - R300 per rack for members / R600 per rack for storage only
Your answer
Enter your current rack numbers (format: shed number-rack number, eg 3-29;3-30; ...)
Your answer
Name & Surname of Paddler 1 *
Your answer
ID Number of Paddler 1 *
Your answer
Canoeing South Africa (CSA) Race Number of Applicant 1 (leave blank if you have not registered with CSA before)
Your answer
Gauteng Canoe Union (GCU) Membership Type for Paddler 1 (this is now compulsory) *
If GCU is registered with another club, please state which club
Your answer
Name & Surname of Paddler 2
Your answer
ID Number of Paddler 2
Your answer
CSA/Race Number of Paddler 2
Your answer
Gauteng Canoe Union (GCU) Membership Type for Applicant 2 (this is now compulsory)
Name & Surname of Paddler 3
Your answer
ID Number of Paddler 3
Your answer
CSA/Race Number of Paddler 3
Your answer
Gauteng Canoe Union (GCU) Membership Type for Applicant 3 (this is now compulsory)
Name & Surname of Paddler 4
Your answer
ID Number of Paddler 4
Your answer
CSA/Race Number of Paddler 4
Your answer
Gauteng Canoe Union (GCU) Membership Type for Applicant 4 (this is now compulsory)
If any members are a Junior, please provide their name & school they attend so that GCU can allocate points to the school for races attended.
Your answer
Cellphone number/s to be registered for gate access (format: +27611231234;+27821231234; ...) *
Your answer
Email address/es *
Your answer
Medical Aid Company & Option *
Your answer
Medial Aid Number *
Your answer
Physical Address *
Your answer
Occupation
Your answer
Emergency Contact Name & Surname *
Your answer
Emergency Contact Number *
Your answer
CSA Indemnity
CCC Indemnity
CCC & CSA Indemnities *
Would you like to be added to our CCC WhatsApp group?
Bank Details: Centurion Canoe Club, ABSA, Cheque Account No. 1024773597, Branch code 632005 *
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