Name: _________________________________________________
Date of Birth: ____________________________________________
Address: _______________________________________________
City, State, Zip: __________________________________________
E-Mail: ________________________________________________
Phone(s): _______________________________________________

Full: $100 [    ]    Student: $50 [    ]
Additional Family Member $20 [   ] (no additional key, no equipment on site and no use of club equipment without the full member present.)

Do you own your own boat? ________  Describe: ____________________
Are you interested in renting storage space? __________________________

Are you interested in using club boat(s)? ____________________________

Are you interested in learning to row? ______________________________

Interests: Sculling _____________  Sweeps _____________  Cox'n ____________

I have read and understand the rules and regulations, bylaws, and constitution. _______
I have signed the waiver: ________________

Print and mail with your check to:
Green Mountain Rowing
9 Andrews Ave
South Burlington, VT 05403-7811

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