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 *
Josh Nelson
Your answer
Gender *
Date of Birth *
Please enter in the form of (dd/mm/yyyy)
Your answer
Email *
This will be the club's main point of contact with you, and will be your username for
Your answer
Confirm email *
Type your email again so we know it's the right one
Your answer
Preferably mobile
Your answer
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)
Your answer
Where are you from?
Do you have any medical conditions that we should know about?
e.g. allergies, asthma etc.
Your answer
Emergency Contact Information
Name *
First and last names!
Your answer
Relationship to you *
Your answer
Phone *
Your answer
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