WEYMOUTH ROWING CLUB

							  Please return completed form and payment to Su Lewis, Membership Secretary, 30 Everest Rd., Weymouth DT4 0DQ
                    WEYMOUTH ROWING CLUB                                              Membership No.
                                                                                      (Club use only)
Membership form for new members, aged 16 and over, using club equipment
                   and premises - April 2011 – March 2012
Please complete all sections, sign and return it with your membership fee to the address at the top of the form.
                           Cheques should be made payable to Weymouth Rowing Club.
Surname:                                               Telephone:
Forename:                                              Mobile No:
Address:
                                                                        Post Code:
Date of birth:                               E-mail address:
Membership           Rowing        Youth (16-21)        Associate (Non –    Family £115 (please attach and return
                     £60          /Student £30          rowing) £5          all family’s forms together)
type

Gender: (please      Ethnic Origin: (please tick)
tick)
Male Female          White     Mixed      Asian or Asian   Black or Black   Chinese or other     Prefer not to say
                                          British          British          ethnic group
Do you have any qualifications (e.g. DCC minibus driver, Power Boat Level 2, Day boat skipper, First
Aid, Coaching award etc.) or skills you would be prepared to use in support of the club? (e.g.
Mechanics, building, painting, carpentry, electrical, legal, accounting, legal advice, marketing,
fundraising, training etc. etc.)


Can you swim 25 metres in rowing kit/light clothing?   YES / NO
If NO, do you understand that you pursue this sport entirely at your own risk without liability on behalf of the
club or its members?            YES / NO
We would prefer you to wear a lifejacket, but the decision is yours if you are over 16.
Are you disabled or suffering from any illness which might impair your rowing capabilities? (eg Bad back,
Asthma, Epilepsy, a heart condition)         YES / NO
If YES: Please give details:
You are advised to consult your doctor before taking part in rowing .
Are you taking any medication which may cause adverse effects if you do physical exercise?
Please give details:
The Club is insured against public liability to third parties but this does not cover the user of club equipment. Do
you understand therefore that you use equipment at your own risk without liability on behalf of the club or its
members? YES        / NO
Please insert information below to indicate who should be contacted in case of an incident/accident:
Emergency contact name:                                   Telephone:

Signature:                                                                         Date:
Membership secretary use only:             Standing Order                            PAYG
Cash/Cheque amount:                        Cheque No:                               To Treasurer: