Please fill in the form below to register with the Wellington Rowing Club.

If you are rowing with the club, this information will be used as your membership form. However, you do not have to row to register your interest in the club, just select "Not-Member" under membership options. You will still need to fill out the 'General Information' table.

(if you have any problems, please contact the web administrator).

Required fields are marked with a '*'.

General Information

First name: *
Last name: *
Email: *
Password: *
Re-enter Password: *
Membership type: *		Non-Rowing MemberNoviceClub Experienced RowerCollege Experienced RowerLearn to RowUniversityCoachMastersCoxLand Based OnlyCorporate

Contact Information (you can now click submit at the bottom of the page if you selected non-member above)

Date of birth: *
Street/Suburb address: *
City: *
Postcode: *
Country: *
Home phone:
Mobile phone: *
School (school rower *):
Parents email (school rower *):

Safety

Emergency contact person: *
Relationship (parent, spouse, etc):
Main contact number: *
Backup contact number: *
Contact street/suburb address:
Contact city:
Contact postcode:
Contact country:
Please list any medical conditions that could affect safety: *		None known

Swimming Ability

Can you confidently swim 50m?: *		yes, I can

Agreement

Signature (please type the numbers you see): *
Date: *
Name of parent/guardian: (under 18 *)
Signature: (under 18 *)		I, the parent/guardian have sighted, and signed this form.
By signing this application you agree to abide by the Constitution and Bylaws of the Wellington Rowing Club. These can also be viewed on the club notice board.