Longridge Canoe Club Membership Application Form 2021/22
Membership Period: 1 May 2021 - 30 April 2022.

The Membership applications are the combination of the form and payment (where applicable). One without the other is not valid.

If this Application is for a person under 18 then this form must be completed by a parent or guardian.

PLEASE NOTE : only Junior or Adult Membership Classes are now operating - other classes and special rates offered in previous years are no longer available.
Email address *
(only enter a junior's email address above if you are content for them to receive emails direct from the Club (and confirmation of this application form), otherwise enter an adult's email details)
Below we are going to ask you to type in a Form Submission Code/Password. This is NOT the same as your password for logging in to the members area.
This is only to stop spammers submitted bogus application forms.

- use the code given to you in the renewal notice/email. Hint: it is a word and a number.
Form Submission Code/Password - Hint: it is a word and a number. *
Membership is open to those who were a member from the year immediately before this renewal; attending our introduction or taster course and were given the Membership Application Form password; spoken with the Club Officials and have been provided with the Membership Application Form password
Membership Type? *
A "Junior" is "under 18" on the 1st of January prior to membership renewal.( i.e. For membership renewal in 2021 juniors will have a date-of-birth with the year 2003 or younger - Having a date of birth 2002 or older requires Adult membership.)
Member's First Name *
Member's Last Name *
Date of Birth *
Please note the date format (UK - dd/mm or USA mm/dd) is set by *your*' google login account settings. You can change this in your google account regional/language preferences.
MM
/
DD
/
YYYY
Street Address *
Address line 2
Town/City *
County *
Postcode *
Telephone Contact Number (Mobile Preferred) *
please enter without spaces such as: 07976123987 or 01628789321.
(only enter a junior's telephone number above if you are content for them to receive direct contact from the Club, otherwise enter an adult's telephone number)
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