CRESCENT BOAT CLUB

5 Boathouse Row, Philadelphia PA 19130
www.crescentboatclub.org

SUMMER 2008 MEMBERSHIP APPLICATION

Name: ______________________________________________________________________

(Please print) Last First MI

Address: ________________________________________________________________

Street City State Zip code

Birth date: ______________________ Home phone: ________________________

Work phone: ____________________ e-mail address: _______________________

Are you a full time student? _____ yes _____ no

If yes, what is the school's name? _________________________________________

Are you a member of any other rowing organization? _____ yes _____ no

If yes, what is the organization's name(s)? __________________________________

Are you a competing rower? _____ yes _____ no

If yes, what is your status for sweeping?

_____ novice _____ junior _____ intermediate _____ senior _____ elite

If yes, what is your status for sculling?

_____ novice _____ junior _____ intermediate _____ senior _____ elite

Can you swim? _____ yes _____ no

Do you have any health problems? _____ yes _____ no

If yes, please explain: ________________________________________________

Signature______________________________________

Date ________________________

***If under 18 years of age include signature of parent or guardian***

Signature of Parent ________________________________________

Date _____________________________

Send this application along with $50.00 deposit check (made out to Crescent Boat Club) to Crescent Boat Club, 5 Boathouse Row, Philadelphia PA 19130