AFFILIATED CLUB:		PANAMUNA OCC		Club Address:	PO BOX 925 MOOLOOLABA Q 4557
MEMBERSHIP RENEWAL - CLUB PADDLER REGISTRATION
Current Member Information			- Please Note CHANGES ONLY -
Name:							Zone Regis No:
Address:
City:							State:	QLD
e-Mail:
Mobile:
Other Information  - PLEASE NOTE CHANGES ONLY
Next of Kin Name:					Relationship:
	Address:				Telephone:
Are you a Competent Swimmer ?				< Select Yes/No	Note: to meet AOCRA safety requirements, each Club is required to ensure member swimming competency, through certification or testing					Yes
Do you suffer any Medical Conditions ?				< Select Yes/No						No
If Yes, please discuss with club registrar / head coach, and please list medical conditions and all pre-existing conditions and injuries:
(such as asthma, heart condition, blood pressure, diabetes, etc.  )
Condition			Treatment					Year
										ACT
										NSW
Do you subscribe to State/Territory Ambulance Service ?					< Select Yes/No	If Yes, Please identify which State >				NT
Are you a Member of a private health care fund ?					< Select Yes/No					QLD
Do you agree for your details to be used for publication ?					< Select Yes/No					SA
Please note your Occupation:										TAS
MEMBER RENEWAL - FEES PAYABLE										VIC
Your Current Membership and Insurance Cover Expires on:			New Member Year		FEES TOTAL					WA
31-December-2007			2008		$300
PAYMENT METHODS
Cash, or Cheque Payable to:
Internet Pay Anyone Transfer To:		Account Name			BSB No.	ACCOUNT No.
		Panamuna Outrigger Canoe Club			014 650	101 298 985
Please Provide a copy of your Internet Payment Receipt with this renewal form
Once you have paid and we have processed your revised information herein provided, your previous membership Contract is renewed for a further 12 months, and
you acknowledge that you continue to be bound by the following Agreements						Paddler Signature		Date:
- To abide by the Rules, Constitution and Directions of AOCRA Inc and the Club - To accept the terms, exclusions, conditions and limitations of I.E.A. Sports Injury and Legal Liability Insurance Contract  - To have read and understand the AOCRA Anti-Doping Policy as published at www.aocra.com.au
Renewal Process Completed Signatures
Club Registrar Signature:			Date:		Zone Registrar Signature			Date: