Membership – 23/24 Season Before completing the form please enusre that you have read and understood your role and responsibilty as a member as outlined in the Members Handbook. Basic InformationFirst Name *Last Name *Email Address *Mobile Phone *Address (Line 1) *Address (Line 2)City / Town *County *Postal Code *Country *AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemen Arab Rep.Yemen DemocraticZambiaZimbabweDate of Birth *Including year of birthCPGA CategoryCPGA Membership NumberIf you have a one. This is not a requirement.Gender *MaleFemalePrefer not to sayAge Category *U16 / Open / Vet / SupervetUnder 14Under 16Open (Under 40)Vet (Over 40)Supervet (Over 50)Selecting Vet or Supervet does not exclude you from racing in the Open catergoryEmergency ContactName *Relationship *Emergency Phone Number *Address (Line 1) *Address (Line 2)City / TownPostal CodeWatersports ReadinessHas your GP ever said that you have a heart condition and that you should only do physical activity recommended by him or her? *YesNoDo you feel pain in your chest when undertaking physical activity? *YesNoIn the past month, have you had a chest pain when you were not undertaking physical activity? *YesNoDo you lose you balance because of dizziness or do you ever lose consciousness? *YesNoDo you have a bone or joint problem that could be made worse by a change in you physical activity *YesNoPlease give detailsAre you pregnant or have you had a baby in the last 6 months? *YesNoIs you GP prescribing drugs (for example water pills) for your blood pressure or a heart condition? *YesNoDo you know of any other reason why you should not exercise? *YesNoPlease tick the box to confirm that you can swim 50m+ *Club RulesPlease tick to confirm your agreement to these rulesRespect *I will treat other members and public as you would expect to be treated regardless of age, gender, ethnicity or ability. Consideration *I will show consideration and avoid causing offence through language or actions which may bring the club or the sport into disrepute.Safety First *I will always adopt a safety first attitude. Looking out for myself and fellow rowers. I will follow instructions during launch, rowing and recovery.Handbook *I have read and understood what is expected of me in the Members Handbook.WebsiteRequired Username (NEW members only)What username would you like to use to login to the website? Returning members do not need to complete this as they will keep their existing username.Password (NEW members only)What password would you like to use to login to the website (this can be changed once you have logged in for the first time). Returning members can continue to use their current password.Membership / PaymentMembership Required *Full MembershipJuniorNon-Rowing / Cox ONLYHow will you be paying your membership fee? *BACS - Full amount (Please use surname as reference)Standing Order (5x consecutive payments of £22)Joined AFTER 01 Jan 2023 (Fee not applicable)Please note that you will need to pay your membership via BACS - we do not offer online payment. Standing Order is NOT available for Junior or Non-Rowing Memberships.Digital SignatureDigital Signature *I confirm that I have read, understood and completed this questionnaire. I understand that I am voluntarily engaging in an acceptable level of exercise and my participation involves a risk of injury. By typing my name here am confirming that I have signed this form electronically. SubmitPlease do not fill in this field.