Application Form
PADDLING ON THE JURASSIC COAST
APPLICATION FORM
NAME:_____________________________________________
DATE OF BIRTH:____________________________________
ADDRESS:___________________________________________
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HOME TEL:__________________________________________
WORK TEL:__________________________________________
EMAIL:______________________________________________
BCU NUMBER:_______________________________________
EXPERIENCE AND BCU QUALIFICATION ( minimum one star )
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Upon acceptance into membership of the Isle of Portland Canoe Club I understand that canoeing is undertaken at my own risk. I confirm that I do not suffer from any disability or medical condition which may render me unfit for strenuous exercise.*
Signed……………………………….. Date……………………………….....
*Should a medical condition exist, this would not necessarily preclude you from membership/participation, but it must be declared. Should you be in any doubt, advice should be sought from your family doctor.
Please return with correct subscription to: Kevin G. Roberts 9 Ludlow Road, Weymouth. DT4 0HB.
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