CCRC Coxswain Registration & Waiver
This form is for COXSWAINS only. No dues are required from non-rowing coxswains but you must complete the form including the CCRC waiver of liability on page 2.
Last Name
Your answer
First Name
Your answer
Gender
Age
Your answer
Birthday
MM
/
DD
/
YYYY
Mobile Phone
(xxx) xxx-xxxx
Your answer
Email
Your answer
Emergency Contact Name
Your answer
Emergency Contact Phone
(xxx) xxx-xxxx
Your answer
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