Back to Membership Main ] Home ]

Coastals Online Membership Application

Please complete the online application below and click the "Next" button. Items marked with an asterisk are required. After you submit your application, you will be directed to the location where you can pay your dues online today. If you like you may print a copy for your records after filling in the fields and before clicking "Next." If you do not wish to submit your application and/or payment online, please click here.

Information listed here is only for club use and will not be provided to any other group for any purpose.

This information will be published in the annual Roster.

Full Name*

Name(s) of family member(s)

Address*

City*
  State*   Zip*   
Home Phone (including area code)

Office Phone

Cell Phone

Email*

Re-enter email address * (for verification purposes)

CaNews Option*
   

   

Directory Option*
   

   

NOTE: If you move, please let us know your new address including a new phone number. This will enable us to update our Membership Directory and redirect your CaNews if you chose the mail option.

1. What type of boat or boats do you own?

2. What is your skill level? Beginner Intermediate Advanced Expert

3. What would you like from the club?

4. How did you hear about us? If someone referred you, please give their name here.

5. What is/are your Coastals Forum user name(s)? Please list each family member and their user name. You must FIRST register on the Forum to fill in this field.

* Member Agreement I hereby state that I have read and agree to abide by the American Whitewater Affiliation Safety Code for all Coastal Canoeists trips on which I am a participant. I understand that I am responsible for my own safety on club trips and that Coastal Canoeists is a voluntary association and coordinates trips and other activities only.
* I agree to pay my membership dues online immediately by clicking "Next" below and using Paypal. (If you don't, click here to mail your application instead).

Only click "NEXT" if you are paying your dues online now. Click here to mail your payment and application.
Click here (javascript must be enabled) to print your form before clicking "next."

hit counter