Centurion Canoe Club

Centurion Canoe Club (CCC) Membership Type *

Family (2 adults, 2 children, includes 1 FoR card) - R4020

Senior (1 adult over 18 years of age, includes 1 FoR card) - R2930

Student (provide copy of student card & must be under 25, no FoR card) - R1700

Junior (under 18 years of age, no FoR card) - R1350

PSC member (must provide proof of PSC membership, no FoR card) - R1150

Pensioner (over 65 years of age, no FoR card, does not include boat rack rental & GCU Fees) - FREE

No club access (only want to store boat at club facilities)

Fullname for Paddler 1 *

ID Number for Paddler 1 *

Date of Birth for Paddler 1 *

Email address for Paddler 1 *

Format: email@domain.com

Cellphone number to be registered for gate access for Paddler 1*

Format: +27611231234

Canoeing South Africa (CSA) Race Number of Applicant 1 (leave blank if you have not registered with CSA before)

If member is a Junior, please specify and provide their the school they attend so that GCU can allocate points to the school for races attended.

Yes

School name

Fullname for Paddler 2 *

ID Number for Paddler 2 *

Date of Birth for Paddler 2 *

Email address for Paddler 2 *

Format: email@domain.com

Cellphone number to be registered for gate access for Paddler 2*

Format: +27611231234

Canoeing South Africa (CSA) Race Number of Applicant 2 (leave blank if you have not registered with CSA before)

If member is a Junior, please specify and provide their the school they attend so that GCU can allocate points to the school for races attended.

Yes

School name

Fullname for Paddler 3 *

ID Number for Paddler 3 *

Date of Birth for Paddler 3 *

Email address for Paddler 3 *

Format: email@domain.com

Cellphone number to be registered for gate access for Paddler 3*

Format: +27611231234

Canoeing South Africa (CSA) Race Number of Applicant 3 (leave blank if you have not registered with CSA before)

If member is a Junior, please specify and provide their the school they attend so that GCU can allocate points to the school for races attended.

Yes

School name

Fullname for Paddler 4 *

ID Number for Paddler 4 *

Date of Birth for Paddler 4 *

Email address for Paddler 4 *

Format: email@domain.com

Cellphone number to be registered for gate access for Paddler 4*

Format: +27611231234

Canoeing South Africa (CSA) Race Number of Applicant 4 (leave blank if you have not registered with CSA before)

If member is a Junior, please specify and provide their the school they attend so that GCU can allocate points to the school for races attended.

Yes

School name

APPLICATION FORM

Paddling on Rietvlei