CAUSEWAY COAST KAYAK ASSOCIATION

MEMBERSHIP FORM 2009

PLEASE PRINT AND COMPLETE ALL OF THIS FORM and return before the end of January.

Name

Email address

Postal address with postcode

Telephone no.

Mobile no.

CANI No.

Coaching qualifications

Names of additional adults                                medical conditions or special needs

Names of children under 18      date of birth   medical conditions or special needs

Name, phone and mobile number, and address of person to contact in the event of an emergency

2009 MEMBERSHIP FEES

Individual membership is open any person over the age of 18.

Individual adult who is a CANI member £25.

Individual adult who is a non-CANI member £25 + £5 CANI insurance = £30

Family membership is £30 with an additional £5 CANI insurance for each adult non-CANI member and £2 CANI insurance for each young person under 18.

The membership year is a calendar year.

Those joining after the end of September will be credited with the following years membership.

I give permission for my child/children to participate in CCKA activities, and understand that there is an element of risk involved, which will be managed by the coach in charge.  The coach may act ‘in loco parentis’ in my absence, if medical treatment is required.  I am responsible for my child’s behaviour at all times.

Signature Parent / Guardian:                                       Date

www.ccka.co.uk