LCR Membership Form

 

NAME:

First Name

Surname

ADDRESS:

Street

Suburb

State    P/C

HOME PHONE:

WORK PHONE:

MOBILE PHONE:

E-mail:

Occupation/School:

Can you swim a minimum of 100 metres?

Do you have any first aid or other relevant qualifications?

Do you have any illness or condition that might affect your safety when boating?

If yes, please describe

Do you wish to store a boat or other equipment at the lake?

If yes, please describe

If under the age of 18, please provide details of your legal guardian below:

NAME:

First Name

Surname

HOME PHONE:

WORK PHONE:

MOBILE PHONE:

E-mail:

Occupation:                                

Subscription & Boat Levy

Club membership;

Subs - $75

Boat Levy - $25

Total - $100 per member/year

Please send cheque payable to Limestone Coast Rowing, PO Box 2071, MOUNT GAMBIER SA 5290

or

Direct Deposit

Account name: Limestone Coast Rowing

Bank: Bendigo Bank

Account Number: 127831238

BSB: 633000

Ref: Your name

 

Note: Please email confirmation of deposit date and details to club@limestonecoastrowing.com

 

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