Membership Form – South Jersey Dragon Boat Club

Contact Information
Name*
Prefix First Middle Last Suffix
E-Mail Address*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Mobile Phone Number*
We use this to contact you and to send immediate blasts for event delays or cancellations.
Mobile Phone Carrier
We use this to send immediate blasts for event delays or cancellations.
Other Phone
Preferred contact method*
- Email
- Mobile Phone
- Other Phone
We will generally communicate through email. Should we need to contact you outside of regular communication, please identify your preferred method.
Date of Birth
Person to Notify in Case of Emergency
Please provide Person to Notify in Case of Emergency
Emergency Contact Name*
First Last
Relationship
Emergency Contact Mobile Phone*
Emergency Contact Other Phone
Our Policy
It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, or age.

We expect our members to observe and respect this policy.
Agreement and Signature
Agreement and Signature*
I understand and accept with the terms of membership
I HAVE COMPLETED THIS APPLICATION AS REQUIRED AND ALL INFORMATION IS TRUTHFUL. I HAVE READ AND UNDERSTAND THE WAIVER AND LIABILITY AGREEMENT AND ASSUMPTION OF THE RISK. BY CLICKING THE SUBMIT APPLICATION, I UNDERSTAND THAT I AM WAIVING CERTAIN LEGAL RIGHTS INCLUDING THE RIGHT TO SUE.
Date*
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Name
This field is for validation purposes and should be left unchanged.

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Contact Information