PO Box 1192 Flanders, NY 11901 631-807-6755

EAST END ROWING MEMBERSHIP APPLICATION Name: ______________________________________ Application Date ____________________ Address:________________________________ City/State___________________Zip:________ Phone: Home:__________________ Office: _________________ Email address:______________________ Birth Date: ______________ USRA # ____________ Profession: _____________________Other Skills/Interests:______________________________ TYPE OF MEMBERSHIP Club _______ Age 19 or older. Access to all rowing club equipment. Eligible to vote for and be elected as an Officer of the Club. Yearly dues $150; Junior_______ Ages 13-19. Participate in organized practices only. No voting privileges. Program fees vary. EAST END ROWING NEEDS YOUR HELP TO MAKE THE CLUB RUN. PLEASE CIRCLE THE COMMITTEES THAT ARE OF MOST INTEREST TO YOU. Membership, Building and Grounds, Fund-raising, Equipment, Newsletter/Website I agree to abide by the Club constitution and other club rules and regulation. I understand that to row out of the Club I must be a member of both East End Rowing.  I will contribute to the management, maintenance, or repair of the club facilities and equipment. I understand that rowing can be a vigorous sport, with implicit hazards for all participants. I certify that I am in good cardiovascular health and have received approval from my doctor to participate in rowing activities. I also certify that I can swim at least one-quarter mile and tread water fully clothed for ten minutes. Signed: ___________________________________ Date: ______________ Parent/Guardian :_________________________________ Date: ______________ Print name: ________________________________________ MAKE CHECKS PAYABLE TO EAST END ROWING Mail to Membership Committee PO Box 1192 Flanders, NY 11901> Please print USROWING WAIVER and mail in with application.