Keel Hauler's Membership Application

If you want to print a PDF copy Click Here

Please print the following information for the membership roster and newsletter mailing label.

Name ____________________________________________________________
           Last Name                                     First Name
Spouse or Significant Other Child's Name  Birth Yr Child's Name Birth Yr
 _________________________________________ _______________ ____ _______________ ____
_______________ ____ _______________ ____
Address _______________________________________________________________
                Number                                              Street
____________________________________________________________ - ____________
City                                                                                          State                          Zipcode                         Zip +4

(____)________________________ (____)________________________ (____)________________________
            Home Phone                                                               Cell Phone (Optional)                               Work Phone (Optional)

Circle which two phone numbers you would like listed in the yearbook


E-Mail ______________________________________

E-Mail - 2 (Optional)______________________________________

Indicate Paddling Interest ______________________________________________________
                           WW-Whitewater, SK-Sea Kayaking, FW-Flatwater, CC-Canoe Camping

We prefer that you read our monthly newsletter on-line
If for some reason you require a hard copy of newsletter, please explain ______________________________________________

The Keel Haulers Board occasionally approves the release of its mailing list to conservation groups or other organizations which it believes would be of interest to its members. If you do NOT want your name released to any group, please check here. _________NO MAILINGS
Club membership Year begins October 1st.              Mail to:
$20 Dues payable beginning Sept 1st each year.  
Dues - $20.00 Per Year  John Kobak
h     1649 Allen Dr.
Make Check Payable to: Keel-Haulers Canoe Club         Westlake, OH 44145-2506

If you want to print a PDF copy Click Here

Or to print just(Hit print FRAME) and Sign Waiver on next page. Club Waiver   

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