DATE: ......
NAME:..................................................................................................

ADDRESS:...........................................................................................
...................................................................................................
...................................................................................................

TEL: .........................................................

JUNIOR / SENIOR / FAMILY / UNEMPLOYED ........ Please circle

AGE IF UNDER 18 ....

INTERESTS WITHIN CANOEING:.........................................................................

OWN EQUIPMENT ? YES/NO

CANOEING EXPERIENCE .............................................................

ANY MEDICAL CONDITION LIKELY TO AFFECT PERFORMANCE
IN ADVERSE CONDITIONS E.G. DIABETES, ASTHMA ETC.:
.......................................................................................................
(If none please state"NONE")

CAN SWIM 50 METRES YES/NO
(All members must be able to swim 50 metres minimum)

FAMILY MEMBERS NAMES AND AGES :
...................................................................................................
...................................................................................................

Membership Fees per person per Annum:
SENIOR £ 15
Unemployed or Junior £ 8
Family - first adult £ 15
- each extra family member £ 6

Fees are due every January but Senior Members joining at other times
during the year will be discounted £1 per month e.g. someone joining in
December would pay £4 and then the full £15 in January and every January thereafter.

I enclose cheque for £.................................... 

SIGNATURE: .....................................................................................
______________________________________________________________________________

PARENTAL CONSENT FOR ALL THOSE UNDER 18
I GIVE MY PERMISSION FOR MY SON/DAUGHTER TO JOIN THE ABOVE CLUB AND CONFIRM
THAT I HAVE READ THE INFORMATION SHEET AND NOTED THE PARAGRAPH ABOUT JUNIORS.

SIGNED PARENT/GUARDIAN:......................................