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Susquehanna Rowing Association - Application for Membership
* = Required

For Family Memberships, this form must be filled out separately for each individual
Is this an application for a new membership or a renewal?  New Application  Renewal
*Name: Date:
       
Address: *Email:
City: State: Zip Code:
*Date of Birth: *Sex: M    F
Home Phone: Wireless:
Occupation/Employer:
If you are applying for a Collegiate Membership, please list your school
Prior Rowing Experience
The officers of Susquehanna Rowing Association will have access to your contact information for Association business. Your information will not be shared in any other way.  If you would like your phone number and email address to be shared with the other members, please indicate so below:

I opt in to share my phone number with all club members:      I opt in to share my email address with all club members:


Price in Parentheses are Sept/Oct Prorated Prices
*Standard Adult: $200 ( $100)
*Introductory: $75
*Convert Introductory: $125 ($25)
*Collegiate: $100 ($50), full time student (12 credits or more, undergraduate or graduate), over the age of 18
*Youth: $75 ($50), any student under 18, who is not part of a family membership
*Family 1st Adult: $200 ($100), 2 or more people at the same address, children still in high school
*Family Each Additional Adult: $50 ($25), 2 or more people at the same address, children still in high school
*Family Each Youth (14-17): $25 ($15), 2 or more people at the same address, children still in high school
1st Adult on Family Membership:
*Out-of-Area: $100 ($50)Individuals 18 years or more of age. His or her permanent residence must be a minimum of 100 miles straight line distance from Gifford Pinchot State Park
Personal Boat Racking: $50:  Check this box to include a personal boat racking fee
State Mooring Permit Fee: $65:  Check this box to include a state mooring fee
* I agree and accept the waiver
 

Total: *How would you like to pay?

Check (Mailing Address will be displaced after submitting this application) 

Paypal or Credit Card

 

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