CAUSEWAY
COAST KAYAK ASSOCIATION
MEMBERSHIP FORM 2008
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
2008
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 + £4 CANI insurance = £29
Family
membership is £30 with an
additional £4 CANI insurance for
each adult non-CANI member and £2
CANI insurance for each child 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:
Please make cheques payable to CCKA and
return with this form to
Mr. Stephen Chapman, 6 Forest Park,
Coleraine, Co. Londonderry,
Northern Ireland, BT52 1JJ