Coastals Mail Membership Application
MAIL FORM AND PAYMENT: Please complete the application below and print it out. Sign and
mail the application with a check for the first year's dues of $20.00 to: Coastals, PO Box 4683, Charlottesville, VA 22905.
This information will be published in the
Name(s) of family member(s)
Home Phone (including area code)
I would like my full-color CaNews newsletter available online weeks before the printed copy is mailed
I would like my monochrome CaNews mailed to me
I would like my Directory available online weeks before the printed copy is mailed
I would like my Directory mailed to me
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?
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 register on the Forum before filling in this field.
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.