Membership Form

KOOTENAY ROBUSTERS MEMBERSHIP FORM
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
Optional for non-paddlers who do not wish to receive Robuster e-mails
Emergency Contact*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Membership Category (Check appropriate box)*

Paddler Survivor - Fee $120Paddler Associate - Fee $120Associate Survivor - Fee $25Associate - Fee $25
Renewal fees are payable by December 31st.
Commitee(s)
Mission Statement

Kootenay Robusters is a non-profit organization for breast cancer survivors and associates to experience physical, emotional, spiritual and mental wellness at a level they find comfortable and personally challenging. Through the dragon boat and other paddling experience, it is our aim to raise awareness of breast cancer and the uplifting truth that there is life after breast cancer.

Value Statement

Kootenay Robusters value:
1. Self determination and the camaraderie, friendship, trust and emotional
  support of the members.
2. The pursuit of a cure for breast cancer.
3. The opportunity to foster courage, hope and positive attitude.
Code of Conduct

Kootenay Robusters will treat everyone with repsect and dignitiy, will be considerate, courteous and supportive. They will take responsibility for thier behaviour.

ON BECOMING A MEMBER OF THE KOOTENAY ROBUSTERS DRAGON BOAT TEAM I AGREE TO EMBRACE THE SOCIETY’S MISSION AND VALUE STATEMENTS, WILL JOIN IN THEIR EFFORTS TO RAISE THE PUBLIC’S AWARENESS OF BREAST CANCER AND WILL SERVE ON AT LEAST ONE COMMITTEE.
Membership Fees Paid:*
Fee is payable by cash, cheque or etransfer to krobusters@gmail.com
Date*

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KOOTENAY ROBUSTERS MEMBERSHIP FORM