Home Forms and Documents New Member Application Form New Member Application Form Full NamePreferred First Name (for ID tag)Residential AddressState/ProvinceZIP / Postal CodeBirth of Date Date Format: MM slash DD slash YYYY Upload Photo*Phone (Home)Mobile No.Membership Type Ordinary (survivor) membership (evidence of breast cancer / prophylactic mastectomy may be required) Supporter membership Name of the local Dragons Abreast group and/or club that you intend to paddlewith?OR Do you wish to join as an individual member? Individual Membership Are you a dragon boat paddler? Yes No Emergency Contact Details Name Phone Number * I am over the age of 18years* I support the objectives of Dragons Abreast Australia* When admitted, I agree to comply with the Constitution and adhere to the policies of Dragons Abreast Australia and I consent to my information being used in accordance with the Dragons Abreast Australia privacy policy* I agree to remain a financial member for Dragons Abreast Australia for the duration of my membership of the above Dragons Abreast Group (Do not check if membership for individual member)Signature of ApplicantDate Date Format: MM slash DD slash YYYY CAPTCHA