Member:

First Name
Last Name
Birthday

# of seasons paddling

Occupation

Dual Member

Home address:

Street
City	State Zip

Contact

Primary E-Mail		Home #
Cell #		Work #
ER Contact Name: ER Contact Phone: ER Contact Relationship:

Medical conditions that we should be aware of:


Is your company possibly interested in sponsoring KG?
Yes No

I would like to be considered for the:
Competitive Team(Bring it on!!!) Please read Coach's Selection Criteria for Competitive Team
Rec Team for now, but would like to go to Competitive or be somewhat in the middle
Strictly Recrational Paddling (Don't stress me out, I wanna enjoy the ride)

I would like to be considered for the position of (feel free to check more than one):

paddler only	stroker	caller
steer	coach	fitness team

I would like to help with (feel free to check more than one):
Fundraising
Social Activities
Community Service
Corpporate Sponsorship

How did you hear about the team?
Friend Please specify name of referral
Flyer
Craig's List
Other Please specify