MEMBERSHIP TYPE
Membership Type: Personal boats: 1x: 2x:
APPLICANT INFORMATION
First Name: Last Name:
Whole Name: US Rowing #:
Street: City:
Home Phone: State: ZIP:
Cell Phone: Work Phone:
Email: Birth Date:
EXPERIENCE
Sculling Experience: Years:
Sweep Experience: Years:
EMPLOYMENT INFORMATION
Employer: Street:
City: State: ZIP:
Phone: Email:
AFFIRMATION
Enter your name to affirm that you can swim.
Signed: Date:
EMERGENCY CONTACT
Name: Cell:
Street: Telephone:
City: State: ZIP:
FEES
ItemCost#Total
Initiation fee$1001$100
Single Membership$3001$300
Total fee$400
SPONSORING MEMBER
Name: Telephone:
SIGNATURE
Enter your name to 'sign' this application.
Name: Date: