Chicago Kayak Member Application

Please provide the following contact information:

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
E-mail
URL

What membership level did you pay for?  Also, how did you pay? 
Example 1  Full Membership-Paypal. 
Example 2  Self Supporting Membership-Check. 
Example 3  Full Membership - it was a gift

Level/Payment Method

Please identify and describe yourself:

Date of Birth
Sex	Male Female

Select any of the following that interests you:

Kayaking
Hiking
Biking
Winter Sports
Volunteering

Let us know about your experience level with outdoor sports, primarily kayaking, but camping, biking, hiking, backpacking, whatever you care to share.

I agree that I have filled out this membership application accurately and will abide by all club rules, wear my PFD on the water at all times, and will respect and help other members.

Yes
No