New Member Application Form

Home Forms and Documents New Member Application Form

Full Name
Preferred First Name (for ID tag)
Residential Address
State/Province
ZIP / Postal Code
Birth 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 Applicant
Date
Date Format: MM slash DD slash YYYY
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