University of Canterbury Canoe Club Membership Form
By submitting this from I understand and accept that the UCCC accepts no liability for injuries or death, or for gear loss or damage arising from club trips. I consent to the collection and retention of the above information by the UCCC for membership records, and the disclosure of this information to national organizations/funding bodies. All information is held in accordance with the Privacy Act 1993.
Your Details
Name *
First and last plz
Gender *
Date of Birth *
Please enter in the form of (dd/mm/yyyy)
Student ID number
Email *
This will be the club's main point of contact with you, and will be your username for uccc.org.nz
Confirm email *
Type your email again so we know it's the right one
Phone
Preferably mobile
Membership Type *
Payment Method *
Paddling Level *
Be very honest here. Over-rating your ability can lead to serious consequences if you end up on a river too hard for you!
Brief description of paddling experience (optional)
Nationality
Where are you from?
Do you have any medical conditions that we should know about?
e.g. allergies, asthma etc.
Emergency Contact Information
Name *
First and last names!
Relationship to you *
Phone *
Submit
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