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.
Date of Birth
Please enter in the form of (dd/mm/yyyy)
This will be the club's main point of contact with you, and will be your username for
Type your email again so we know it's the right one
Student membership ($20)
Non-Student membership ($25)
Only around for 1 semester ($10) EXCHANGE STUDENTS ONLY
Online Transfer to 02-0875-0169255-000
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)
Where are you from?
Born and bred kiwi
Do you have any medical conditions that we should know about?
e.g. allergies, asthma etc.
Emergency Contact Information
First and last names!
Relationship to you
Page 1 of 1
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service