Form

MUSKOKA PADDLE CLUB REGISTRATION
New MemberRenewal
Adult (18 and older) $70Senior (65 and older) $60Couple (Two adults) $120Youth (17 and under) $50Family (Two adults, Two children) $190Additional child $25
Payment Type*
PAYMENT MUST BE MADE AT TIME OF REGISTRATION.

ETRANSFERS CAN BE SENT TO muskokapaddleclub@gmail.com

THOSE CHOOSING TO PAY BY CHEQUE WILL BE CONTACTED BY THE CLUB TO MAKE PAYMENT ARRANGEMENTS
REGISTRANT #1
Name*

First NameLast Name
Email*
example@example.com
Date of Birth (Day/Month/Year)*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact (Name and Telephone Number)*
Medical Concerns*
Registrant #2
Name

First NameLast Name
Email
example@example.com
Date of Birth (Day/Month/Year)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact (Name and Telephone Number)
Medical Concerns
Registrant #3
Name

First NameLast Name
Email
example@example.com
Date of Birth (Day/Month/Year)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact (Name and Telephone Number)
Medical Concerns
Registrant #4
Name

First NameLast Name
Email
example@example.com
Date of Birth (Day/Month/Year)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact (Name and Telephone Number)
Medical Concerns
YES
YES
Signature*

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MUSKOKA PADDLE CLUB REGISTRATION

REGISTRANT #1

Registrant #2

Registrant #3

Registrant #4