Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Birthdate *

MM

DD

YYYY

Emergency Contact Phone *

(###)

###

####

I am a Breast Cancer Survivor *

Yes

Please check one of the following: *

Able to swim 50m or more

Weak or non-swimmer but comfortable in water

Non-swimmer, not comfortable in water

Code of Conduct *

Please review our code of conduct (click the link): Bernie's Boat Code of Conduct. Return to this page after reading and acknowledge it below.

I acknowledge Bernie's Boat Code of Conduct

Waiver *

Please review the waiver (click the link): Bernie's Boat Waiver. Return to this page after reading and acknowledge that you'll sign it below.

I have read the waiver and will sign at first practice

Membership Level *

Full membership includes paddling, hat, and jersey, plus newsletters, social events, and meetings. Associate membership includes newsletters, social events, and meetings only.

Full Annual Membership: $200

Associate Annual Membership: $25