Mevagissey Rowing Club: Membership Renewal/Application

Mevagissey Rowing Club

Membership renewal/application form 2023/2024
Name

First NameLast Name
Email (this will be used as your CPGA username if you permit us to upload your details)
example@example.com
I give permission for the club to upload my details to CPGA
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityCounty

Postcode
Birth Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Can you swim 200 metres:
Please indicate your chosen membership:
Do you suffer with any illnesses we should be aware of? If Yes, please detail below:
Please provide details of who should be contacted in case of emergency below:
Please pay the appropriate Membership fees to:

Mevagissey Rowing Club

Account Number: 12528309

Sort Code: 09 01 51

Please include your name and type of membership in your payment reference and make payments by 30th April.
All information is treated as Confidential and not shared.
Should be Empty: