New Membership Application Form
Personal Information
First name *
Your answer
Surname *
Your answer
I Like to be known as (nickname)
Your answer
Address *
Your answer
Suburb *
Your answer
State *
Postcode *
Your answer
Date of birth *
MM
/
DD
/
YYYY
Phone number *
Your answer
Email address *
Your answer
Occupation
Your answer
Emergency Contact Information
In the event of an incident during a session the following person should be contacted (for paddlers aged under 18 this must be a parent or principal carer) - this person should be someone that will not be in the boat:
Name *
Your answer
Phone number *
Your answer
Email
Your answer
Relationship to me *
Your answer
Health and Fitness
I have the following medical information which should be known by the session leaders:
Condition
Your answer
Which is managed by
Your answer
I confirm that I can swim at least 50 metres in my paddling clothing, without a flotation device *
I have been dragon boating before my application to join YRD *
If yes, please give details of your prior experience. If you were a member of another club please include the club's names and when you were an active member. Please note we may contact the club for a reference check.
Your answer
What do you want to achieve from the sport and from YRD? *
e.g. fitness, competition, meet new people
Your answer
Details of any relevant qualifications (e.g. first aid, coaching, accredited sweep level)
Your answer
By submitting this form, I declare that the above information is correct to the best of my knowledge
Your application will be sent to YRD committee for approval. Once approved a committee member will contact you shortly to discuss membership fees.
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