Centurion Canoe Club
Membership Form for the period Jan 2020 - Dec 2020
Centurion Canoe Club (CCC) Membership Type *
Are you a new or renewing CCC Member? *
Would you like an additional FoR (Friends of Rietvlei) card @R190?
If answered "Yes" to above question, please add name & contact number for FoR card. If answered "No" ignore
Your answer
How many boat racks do you want to rent - R320 per rack for members / R650 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) - Fees TBC, renewable April Annually *
If GCU is registered with another club, please state which club
Your answer
Name & Surname of Paddler 2 (only applicable for Family membership)
Your answer
ID Number of Paddler 2 (only applicable for Family membership)
Your answer
CSA/Race Number of Paddler 2 (only applicable for Family membership)
Your answer
Gauteng Canoe Union (GCU) Membership Type for Applicant 2 (this is now compulsory - only applicable for Family membership) - Fees TBC, renewable April Annually
Name & Surname of Paddler 3 (only applicable for Family membership)
Your answer
ID Number of Paddler 3 (only applicable for Family membership)
Your answer
CSA/Race Number of Paddler 3 (only applicable for Family membership)
Your answer
Gauteng Canoe Union (GCU) Membership Type for Applicant 3 (this is now compulsory - only applicable for Family membership) - Fees TBC, renewable April Annually
Name & Surname of Paddler 4 (only applicable for Family membership)
Your answer
ID Number of Paddler 4 (only applicable for Family membership)
Your answer
CSA/Race Number of Paddler 4 (only applicable for Family membership)
Your answer
Gauteng Canoe Union (GCU) Membership Type for Applicant 4 (this is now compulsory - only applicable for Family membership) - Fees TBC, renewable April Annually
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 *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy