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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