Become a Member - Scranton Canoe Club

Scranton Canoe Club Membership Application

Please complete all sections.

Personal Information

Please choose the membership you are applying for

Your Name(Required)

First Last

Your Address(Required)

Street Address Address Line 2 City State ZIP Code

Your Email Address(Required)

Email Address Confirm Email Address

Your Phone(Required)

Date of Birth(Required)

Marital Status(Required)

Spouse Name(Required)

Employment Information

Business or Profession(Required)

Name of Employer(Required)

Employer's Phone(Required)

Employer Address(Required)

Street Address Address Line 2 City State ZIP Code

Years at this Job

Miscellaneous Information

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

What Civic Activities do you participate in?(Required)

Are you related to a member or members?(Required)

Yes

Member Name 1

First Last

Relationship to Member 1

Member Name 2

First Last

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(Required)

First Last

Club Sponsor 2(Required)

First Last

Board of Directors Sponsor(Required)

First Last

Are you a member of any other Country Club?

Yes

Country Club Name

Length of Membership

Country Club City

Contact

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

Yes

Membership Agreement

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:

Do you accept these terms(Required)

Yes