Centurion Canoe Club

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: 10 digit number (e.g., 0615190427)

Paddle Sport South Africa (PSA) Race Number of Applicant 1 (leave blank if you have not registered with PSA before)

If member is a Junior, please specify and provide the school they attend so that PSG 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: 10 digit number (e.g., 0615190427)

Paddle Sport South Africa (PSA) Race Number of Applicant 2 (leave blank if you have not registered with PSA before)

If member is a Junior, please specify and provide the school they attend so that PSG 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: 10 digit number (e.g., 0615190427)

Paddle Sport South Africa (PSA) Race Number of Applicant 3 (leave blank if you have not registered with PSA before)

If member is a Junior, please specify and provide the school they attend so that PSG 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: 10 digit number (e.g., 0615190427)

Paddle Sport South Africa (PSA) Race Number of Applicant 4 (leave blank if you have not registered with PSA before)

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

Yes

School name

APPLICATION FORM