Become a Member

Scranton Canoe Club Membership Application

Please complete all sections.

* indicates required field

Personal Information

Please choose the membership you are applying for:*

First Name:*

Last Name:*

Phone:*

Email:*

Address:*

City:*

State:*

Zip:*

Date of Birth:

Marital Status:

Spouse Name:

Employment Information

Business or Profession:*

Name of Employer:*

Employer's Phone:*

Employer Address:*

Employer City, State, Zip:*

Years at this Job:*

Miscellaneous Information

What local Community Organizations or other affiliations do you belong to?

What Civic Activities do you participate in?

Are you related to a member?*

Member Name:

Relationship to Member:

Member 2 Name:

Relationship to Member 2:

Two member sponsors plus one Board of Directors sponsor is required on all applications. Please list the names of 2 sponsors who are members of Scranton Canoe Club:

Club Sponsor 1:*

Club Sponsor 2:

Board of Directors Sponsor:*

Are you a member of any other Country Club?

Country Club Name:

Length of Membership:

Country Club City:

Contact:

Have you ever been rejected, expelled, or resigned from any other club?*

Membership Agreement

If elected to membership, I agree to abide by all rules and regulations at the Scranton Canoe Club as provided by its by-laws and resolutions thereof.

Do you accept these terms?*