Membership Renewal Form

MMCC Membership Renewal Form 2019–2020

Please note this form is for existing club members only. Payment is via PayPal.

Required fields are marked with *

Name*

First name

Surname
Date of Birth*
Address*

Street Address

Suburb / City

State

Postcode
Phone*
Email
Emergency Contact Name*

Name
Emergency Contact Phone*
Club Membership Fees
Annual club registration renewals (existing members)
Junior (Under 18 years) : $30
Senior (18 years and over) : $50
Volunteer Membership : $0.00
Family Renewals please contact the Secretary at mittamittacanoeclub@gmail.com
Paddle Victoria Fees*
Please select your Paddle Victoria Fees, these are compulsory.

Full membership – Senior Paddler (over 18) : $95
Full membership – Junior Paddler (under 18) : $45
Volunteer Membership : $0.00
Family Renewals please contact the Secretary at mittamittacanoeclub@gmail.com
Boat Storage
I hereby apply for boat storage space. I understand that the boatshed manager will allocate me storage space when it becomes available at an annual fee of $90.00 per rack and that I store my boat at my own risk.

Price: $ 90.00

Quantity:
Boat 1 (Type, make, colour)
eg: K1, Weapon, yellow-white
Boat 2 (Type, make, colour)
Boat 3 (Type, make, colour)
Boat 4 (Type, make, colour)
Your Total
$ 0.00
Agreement Acceptance*
- I have read, understand, and accept all Terms and Conditions. I have also read and accept the Mitta Mitta Canoe Club Privacy Statement. I have also read and understood and agree to abide by Canoeing Victoria’s Child Safety Code of Conduct.