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SAN JUAN DRAGONBORN CLUB, INC.
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MEMBERSHIP APPLICATION
Please complete membership application form fully and sing attached release and waiver of liability. Return
application form, release and waiver of liability, full membership payment to San Juan Dragonborn Club, Inc.
and copy of current student status (if applicable) to our Membership Director or Treasurer.
APPLICANT INFORMATION:
Name:________________________________________________________________________________
Address:______________________________________________________________________________
______________________________________________________________________________
City/Town:_______________________________________________ State:_______ Zip:____________
Home Tel.:___________________ Cell Phone:__________________ Other Phone: _________________
E-Mail Address:________________________________ Date of Birth:_______________ Height:__________
Paddle side preference (select one): Left ⃝ Right ⃝
Weight:____________
Please list dragon boat or paddling/rowing experience:
EMERGENCY CONTACT INFORMATION:
Name:_____________________________________________
Telephone:
Relationship:
HOW DID YOU LEARN ABOUT US:
⃝ NEWSPAPER
⃝ WORD OF MOUTH
⃝ RADIO
⃝ WEBPAGE
⃝ CLUB ORGANIZATION
⃝ OTHER
MEMBERSHIP TYPES/FEES:
⃝ 1 Year membership (1A) = $ 250. :Expires in 12 consecutive months. Includes at least 3 practices per week.
⃝ 6 Month membership (6M) = $ 130 : Expires every 6 consecutive months. Includes at least 3 practices per
week.
⃝ Student-1 Year membership (1E) = $ 150. :Expires in 12 consecutive months. (Must provide evidence of
current student status for high school, undergraduate or graduate college/university). Includes 2 practices per
week.
⃝ 1 Month membership (1M) = $ 25. :This is a “to try” membership. Expires in 4 consecutive weeks.
Note: Membership fee is non-transferable, and non-refundable. A $25 charge will be added for returned
checks due to non-sufficient funds.
Please list your reason to join the SJ Dragonborn Club: ⃝ Paddling
⃝ Steering
⃝ Drumming
⃝ Coaching
⃝ Club organization ⃝ Other
I Certifiy acceptance to abide by the rules, the regulations and bylaws of the SJDC :
X____________________________________________________
(Signature)
____________________
(Date)
San Juan Dragonborn Club • www.facebook.com/San Juan Dragonborn Club • [email protected]