USRowing Individual Member Agreement

USRowing Individual Member Agreement
Please read the agreement and waiver below, then complete the form.
Participant Name*

First NameLast Name
Email (copy of form will be emailed to this email)*
example@example.com
Participant Date of Birth*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Signature*
Printed Name:*

First NameLast Name
Date of Form Completion*

MonthDayYear
Date
PARENTAL/GUARDIAN NAME & SIGNATURE (IF PARTICIPANT IS UNDER 18 YEARS OF AGE):
Parent Name/Guardian

First NameLast Name
Parent/Guardian Signature
Should be Empty: