Name: __________________________________________________

Address: _________________________________________________

City: _________________________ State: _____ Zip: ____________

To be considered for membership, please fill out this application in its entirety.

To receive all club benefits, a $25 membership fee is required.

Name(s) of immediate family members who may join: ______________________________________

Home phone: ______________________________ Work phone: _____________________________

E-mail address: _______________________________________

What is your skill level?  Beginner  Intermediate  Advanced  Expert

What type of whitewater boat(s) do you own, if any?

How can Richmond Whitewater Club benefit you best?

What other skills, certifications etc. do you have that would help support the club?

I hereby state that I have read and agree to abide by the American Whitewater Affiliation Safety Code for all Richmond Whitewater trips on which I am a participant. I understand that I am responsible for my own safety on club trips and that Richmond Whitewater Club is a not for profit, voluntary association and coordinates activities only.

The Richmond Whitewater Club Promotes Whitewater Education and Conservation

Signature: ____________________________________________ Date: _______________________

RWC-8/00