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Name*
First Last
Email*
Phone*
Member Details
Date of Application
DD slash MM slash YYYY
Home Phone
Date of Birth*
DD slash MM slash YYYY
Gender*
- Male
- Female
Address
Street Address City State Postcode Country
Preferred Group*
- Minnows (8-9)
- Juniors (10-17)
- Adults (18+)
- Social Members
- Supporters
Emergency Contact Details
Name*
First Last
Mobile Phone*
Home Phone
Email*
Relationship*
Questionnaire
Are you able to swim 400 metres (any stroke, no time limit) and tread water for 5 minutes ?*
- Yes
- No
Do you have a medical condition that could impact your safety or the safety of others when training or racing Outrigger Canoes?*
- Yes
- No
Have you participated in our free training trial or open days?
- Yes
- No
Have you been a member of another outrigger canoe club?
- Yes
- No
If so, who?
Reason for leaving that club?
What experience do you have as a paddler? (years and months)
Have you competed in Outrigger or Dragon Boat paddling before? Please state where
If an experienced paddler, what is your preferred seat?
Do you have any existingMedical Conditions or injuries?*
Comments
Print Your Name*
In submitting this Online Membership Application, I certify that the above information is correct and complete and do hereby agree to abide by the Membership Conditions.
Please make it your priority to peruse our Club documents below
- Members & Coaches Code of Ethics & Conduct
- Crew Selection Criteria
- Event Registration & Race Fee Policy

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