Healing Dragons Registration Form

Healing Dragons of Charlotte

Annual Membership Form
Empowering cancer survivors and supporterd to build strenght, couracge, and community thorugh dragon boat paddling

Our Mission:
Healing Dragons, a non-profit organization, empowers cancer survivors and supporters to be courageous through the team sport of dragon boat paddling.
Our Vision:
Our vision is to provide a restorative path for cancer survivors and supporters to achieve emotional and physical wellness.
Our Core Values:
We live by the values of teamwork, community, fun, authenticity, friendliness, respect, diversity and inclusion.
- New MemberReturning Member
- Name*
  
  First NameLast Name
- Birthday*
  
  MonthDayYear
  Date
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Email*
  example@example.com
- Phone Number*
  Please enter a valid phone number.Format: (000) 000-0000.
- EmailText MessagePhone CallMail
- SurvivorFriend/Family of a SurvivorOther
- If survivor, what type of cancer?
- If survivor, what is your Cancer Anniversary date?
  
  MonthDayYear
  Date
- Emergency Contact*
  
  First NameLast Name
- 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
- Social MediaCoachingSteeringEquipment Set-upSocial EventsMarketingCommunity EngagementMembershipLeadershipSafetyBoat Maintenance
- Existing MemberFriend/FamilyNewspaper or MagazineWebsiteWeb SearchFacebookMeetupDoctorOther
- Product Order
  prevnext( X )
  
  Annual Team Membership
  The Annual Team Membership Fees are used by Healing Dragons to fund core team expenses such as insurance, regional dragon boat association fee, marketing materials and equipment needs. The team provides paddles, personal flotation devices (PFDs) and the boat.
  
  $100.00
  
  
  
  Team Jersey (Sleeveless)
  Limited sizes are available until inventory is restocked
  
  $50.00 T-ShirtQuantity
  
  
  
  Team Jersey (Short Sleeve)
  Limited sizes are avaiable until inventory is restocked
  
  $50.00 T-ShirtQuantity
  
  
  
  Team Jersey (Lady Cap Sleeve)
  Limited sizes are available until inventory is restocked
  
  $50.00 T-ShirtQuantity
  
  
  
  Total
  
  $0.00
- ACCEPTED FORM OF PAYMENT:
  
  Check: Pay to Healing Dragons, Inc. Check may be mailed in, or given to our Treasurer, or Captains.
  
  Zelle: Send to HealingdragonsCLT@outlook.com (no service fee)
  
  PayPay: Send to HealingdragonsCLT@outlook.com. Please add 4% to your payment to defray the PayPal service fee.
  
  Cash: May be given to our Treasurer, or Captains, preferably in an envelope. Clearly write your name and amount on the outside of envelope. Please do not mail cash.
  
  Checks may be mailed to:
  
  Healing Dragons of Charlotte
  
  P.O. Box 2521
  
  Cornelius, NC 28031
- Please note that Healing Dragons welcome all cancer survivors, family or friends of cancer survivors. If you wish to join but have a financial hardship, you may contact our President for a private and confidential discussion about financial assistance, at eileenmp06@gmail.com.
- I understand that I must sign a separate liability waiver before participating.I agree that Healing Dragons may use photos/videos of me for marketing purposes.I consent to my contact information being shared internally with team members.
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Healing Dragons of Charlotte