2012 Keel-Hauler Membership Application
Please fill out all applicable information

Read Waiver "Member's Mutual Agreement for Protection from Liability" at this Link - Read the Waiver
Please indicate that you have read and agreee to Membership Liability Waiver
I agree to liabilty Waiver
Please indicate if you are a current member and only making changes
I am a current club member
First Name
Last Name
Spouse or Significant Other First Name
Spouse or Significant Other Last Name, only if not the same
Address
City
State
zipcode - add zip+4 if you can
Home Phone
Cell Phone
Work Phone
In addition to home phone which phone should be listed in our yearbook?
Cell
Work
Children's Names / Birth Year
Primary E-Mail
Alternate E-Mail
Club Newsletter
Read On-Line, Save the postage
Mail me a Newsletter
Can the club ever share your membership Information?
Share only with KHCC Board Approval
Do not Share my Information with anyone
Please indicate all your paddling interests
Whitewater - WW
Sea Kayaking - SK
Canoe Camping - CC
Flat Water - FW
Any Questions or Comments?
Membership Cost and Terms

* Club Membership Year ends Oct 1st no matter when you join .
* Membership Dues are $20.00 Per Year or $21 if using Paypal.
* If you join from June 15th to August 15th dues are only $10.00.
* Our Yearbook & Roster is distributed in February or until we run out.
* The December newsletter is the last one you will receive until you renew.
OR

Web Author:  John Kobak;  Treasurer - Joe Marksz
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Revised:10/28/10