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

Check here if you want a monthly newsletter mailed to you. We prefer that you read on-line   I like Snail-Mail _________

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
Dues $10 after 7/15 each year plus $5 for a Yearbook if still available	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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