Learn to Row Application

 

 

 

Name:______________________________________________

 

Address:____________________________________________

 

City:___________________________   State:______________

 

Zip:____________  Email:______________________________

 

Daytime Phone:_______________________________________

 

Mobile Phone:________________________________________

 

Social Security Number:________________________________

 

Birth Date:___________________________________________

 

Male:______  Female:______ 

 

Fee: $500

Session: __________

 

Please make Checks payable to: New Rochelle Rowing Club

 

I certify that I am able to swim and can stay afloat for 10 minutes

 without aid. _________ (Initials)

 

 

________________________________________________________________

Signature                                    Printed Name                                    Date

New Rochelle Rowing Club