CRESCENT BOAT CLUB

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

SUMMER 2009 MEMBERSHIP APPLICATION

Name: ______________________________________________________________________

(Please print) Last First MI

Address: ________________________________________________________________

Street City State Zip code

Birth date: ______________________ Home phone: ______________

Workphone:____________________e-mail address:__________________

Are you a full time student? _____ yes _____ no

School's name? _________________________________________

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

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

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

Total fee for summer program is $525.00. For anyone who has had no previous rowing experience there is an additional $75 fee for new rowers for privately-tutored Introduction to Rowing lessons.