CDBA Annual Membership Form

Annual 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.Format: (000) 000-0000.
Email
example@example.com
- Emergency Contact
  
  First NameLast Name
- Relationship
- Emergency Contact Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Please consult your physician before participating in dragon boat paddling if you have any medical concerns.
- Medical Emergency Information
  Please indicate any special medical emergency items that the Team Captain/Coach should be aware of, such as allergies, inhalers, etc.
- Dietary Restrictions
- Are you a New Member
- To help CDBA from incurring PayPal surcharges, please use Zelle.
- Type of Payment
- Please Zelle ${areYou} to jclchen.nc@gmail.com
- Zelle Proof of Transfer
  
  Please upload a screenshot of the Zelle transaction receipt
  Cancelof
- Please make check payable to Charlotte Dragon Boat Association in the amount of ${areYou} and send to:
  
  CDBA
  4700 Carson's Pond Rd
  Charlotte, NC 28226-3204
- I acknowledge I have received & reviewed the information in the Handbook and agree to abide by its requirements.
- Signature
- Date
  
  MonthDayYear
  Date
Should be Empty: