JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
NTW Membership Form 2019 - 2020
Individual form per paddler
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Type of membership
*
Adult
J19
J16
Intermediate
Midget
Required
First Name
*
Your answer
Surname Name
*
Your answer
Postal Address
*
Your answer
Phone
Your answer
Email
Your answer
Gender
*
Female
Male
Date of Birth
*
MM
/
DD
/
YYYY
Do you or your whanau have skills or expertise you may be willing to share with NTW? Please elaborate and identify contacts unless otherwise provided.
Your answer
Are you a registered tribal member of Waikato Tainui?
*
Yes
No
Iwi / Hapu Affiliation
Your answer
Emergency Contact 1 - Full Name
*
Your answer
Emergency Contact 1 - Relationship
Your answer
Emergency Contact 1 - Home/Work/Mobile
*
Your answer
Emergency Contact 2 - Full Name
Your answer
Emergency Contact 2 - Relationship
Your answer
Emergency Contact 2 - Home/Work/Mobile
Your answer
Do you suffer from any health problems, disabilities or injuries that may affect your ability to paddle?
*
Yes
No
If yes, please state what the health problem(s) are (e.g. asthma, stroke victim) and which listed paddler it relates to.
Your answer
Club membership fee information
I accept responsibility for the fees associated with this membership registration.
*
Yes
Required
Parental consent is required for all people under the age of 18 years. By submitting the enclosed membership details, I confirm that it is accurate and that I am 18 years or over and accept payment of membership fee.
*
Yes
Required
Name of person submitting membership form
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
