KCKA MEMBERSHIP APPLICATION

PLEASE PRINT LEGIBLY  Date:_________________

Name#1 ___________________________________________________________________

Name#2 ___________________________________________________________________

   

 

 

Address/City/Zip: _____________________________________________________

Phone: _________ - _________ - ________ 

E-mail: _________________________________

My areas of interest include (check all that apply):

[   ]  Family/Flatwater Canoeing (Class I-II)

[   ]  Kayak Touring (Class I-II)

[   ] Whitewater Canoeing/Kayaking/Rafting (Class III+)

CHECK ONE TYPE OF MEMBERSHIP:

________ $15.00 Single / Family Membership

________ $65.00 Associate/Business Membership

 (w/a 6 column inch KCKA Newsletter ad & KCKA website ad)

________ $200.00 Life Membership (does not include chapter dues)

________ My additional contribution to KCKA Conservation-Access Program

OPTIONAL CHAPTER AFFILIATIONS

________ $5.00 Kayak Chapter

$________ TOTAL OF ALL FEES

Please fill out this form completely, even if you are renewing. 

Send the application and your check for TOTAL OF ALL FEES to:

Kansas Canoe & Kayak Association; PO Box 44-2490; Lawrence, KS 66044

 

Please tell us how you heard about the Kansas Canoe & Kayak Association - check all that apply:

[   ]  From a friend who boats

[   ]  Another KCKA Member

[   ]  KANSAS PADDLER Home Page

[   ]  Information at a business, name::_______________

[   ]  Article in News Media

[   ]  A KCKA activity booth

[   ]  Other:__________________

KCKA depends upon volunteer efforts. I am willing to help with these activities:

[   ]  Marketing/Membership [   ]  Flatwater/Touring Trips [   ]  Whitewater Trips [   ]  Instruction/Safety [   ]  Special Events, Rendezvous, etc [   ]  Website

General Waiver & Liability Release

I, THE UNDERSIGNED, HEREBY ACKNOWLEDGE THAT I AM AWARE THAT THERE ARE CERTAIN ELEMENTS OF DANGER INHERENT IN BOATING ACTIVITIES WHICH ARE BEYOND THE CONTROL OF KANSAS CANOE ASSOCIATION (KCKA), ITS TRIP COORDINATORS, CLUB MEMBERS, CLUB OFFICERS AND THE BOARD OF DIRECTORS, AND THAT PARTICIPATION IN THESE EVENTS AND OTHER ACTIVITIES SUCH AS FLOAT TRIP AND CAMP OUTINGS, ENTAILS UNAVOIDABLE RISK AND POSSIBLE LOSS OF LIFE AND OR PROPERTY. IN CONSIDERATION OF THE KCKA, TRIP COORDINATORS, OFFICERS, BOARD OF DIRECTORS AND MEMBERS OF KCKA, I DO HEREBY FOR MYSELF AND FOR ALL WHO MAY HEREAFTER CLAIM THROUGH OR FOR ME, WAIVE AND RELEASE ALL FUTURE CLASSES, RIGHTS AND CAUSES OF ACTION ACCORDED IN MY FAVOR AS A RESULT OF PERSONAL INJURIES, LOSS OF LIFE OR LOSS OF PROPERTY WHICH I MAY SUFFER WHILE PARTICIPATING IN CLUB EVENTS, AGAINST THE PEOPLE AND ORGANIZATION OF THE KCKA AS DESCRIBED ABOVE AND I FURTHER HEREBY COVENANT AND AGREE, THAT NO SUIT OR ACTION AT LAW SHALL BE INSTITUTED FOR THE ABOVE REASONS BY ME OR OTHERS IN MY BEHALF OR IN MY RIGHT. HAVING READ AND UNDERSTANDING THE ABOVE, I FREELY SIGN THIS WAIVER AGREEMENT.

Name (s) ___________________________________________________________________ 

Date ______________

Address __________________________________________________________________________________

City, State, Zip __________________________________________________________________________________

Phone ________________________

Whom to Notify in Emergency ___________________________________________________________________

Emergency Address & Phone ____________________________________________________________________

Signature (s) X__________________________________________________________________________________

Signature of Parent/Guardian (required if under 21) ________________________________________________

Address & Phone of Parent/Guardian _____________________________________________________________

The Kansas Canoe and Kayak Association (KCKA), organized April 26, 1975, is a Kansas Not-For-Profit Corporation. KCKA is an organization of canoeists, kayakers, and rafters working together to promote river running, education, conservation, access and related activities. Various Chapters of KCKA may be established within KCKA to help support the specific interests of Chapter members.  KCKA Bylaws, Outdoor Code, KCKA History, Paddling Tips, Trip Waiver Forms, a list of businesses that extend KCKA Members a discount, and much more can be found on-line in the KANSAS PADDLER Home Page on the Membership Page

Please mail this form to: Kansas Canoe & Kayak Association - PO Box 44-2490, Lawrence, KS, 66044-8939 - ___ New Membership / ___Annual Membership Renewal