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?
Clear selection
If answered "Yes" to above question, please add name & contact number for FoR card. If answered "No" ignore
How many boat racks do you want to rent - R320 per rack for members / R650 per rack for storage only
Enter your current rack numbers (format: shed number-rack number, eg 3-29;3-30; ...)
Name & Surname of Paddler 1 *
ID Number of Paddler 1 *
Canoeing South Africa (CSA) Race Number of Applicant 1 (leave blank if you have not registered with CSA before)
Have all paddlers on club membership registered for Canoeing South Africa (CSA)/Gauteng Canoe Union (GCU) Membership? This is now compulsory and club access will not be granted without up-to-date CSA/GCU membership. NOTE: New members, instructions on how to register will be on club invoice. *
If CSA/GCU is registered with another club, please state which club
Name & Surname of Paddler 2 (only applicable for Family membership)
ID Number of Paddler 2 (only applicable for Family membership)
CSA/Race Number of Paddler 2 (only applicable for Family membership)
Name & Surname of Paddler 3 (only applicable for Family membership)
ID Number of Paddler 3 (only applicable for Family membership)
CSA/Race Number of Paddler 3 (only applicable for Family membership)
Name & Surname of Paddler 4 (only applicable for Family membership)
ID Number of Paddler 4 (only applicable for Family membership)
CSA/Race Number of Paddler 4 (only applicable for Family membership)
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.
Cellphone number/s to be registered for gate access (format: +27611231234;+27821231234; ...) *
Email address/es *
Medical Aid Company & Option *
Medial Aid Number *
Physical Address *
Occupation
Emergency Contact Name & Surname *
Emergency Contact Number *
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
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