Membership Application Form
Whakatane Rowing Club
Last Name *
Your answer
First Name *
Your answer
Gender *
Emergency Contact Name *
Your answer
Emergency Contact Number *
Your answer
Emergency Contact Relationship *
Your answer
Email Address (U18 Parent or Guardian) *
Your answer
Postal Address *
Your answer
Rowers Date of Birth: NB American Format *
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DD
/
YYYY
Select Membership Type *
Are you able to Swim 50Meters? *
Do you have any Medical, Behavioural or Learning Conditions? *
For safety reasons we require full disclosure of any medical conditions to ensure your safety on and off the water
Your answer
Have you been a member of another rowing club previously?
What year did you first join Whakatane Rowing Club? *
Your answer
Do you currently attend School? *
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