Application for Renewal of Membership 2017 – 2018 (Due 30May2017)

Surname: / Name / Cell
Home Tel / Work Tel
Gender / M / F / Family / Single / ID No / email
Postal
Address
Spouse / ID No / Cell
Gender / M / F / email
Kayak: Indicate your Interest / qualification
Canoe Polo / Surf Ski / Qualification / Canoeing / Qualification
Diving: Indicate your Interest and certification where possible
Snorkeling / Underwater Hockey / Scuba Diving / Underwater Photography
Spear fishing / Compressor Operator / Dive Instructor
Fee Structure
Item / Description / Standard Fees / Total Amount
1 / Family Subscription / R 1020 / R
2 / Single Subscription / R720 / R
3 / Junior Subscription / R380 / R
4 / Country Member / R380 / R
5 / Joining Fee (50% of membership fee) / R
6 / KNCU Seniors
Number / R 725 / R
7 / KNCU Juniors
Number / R 235 / R
9 / RacksNumbers / R 210 / R
10 / Remotes / R150 / R
11 / Total Amount Due to the Zululand Kayak Club / R

1)I am aware of the potential dangers involved in the participation of Kayaking, Diving and associated activities.

2)I am further aware that the Zululand Undersea Club / Zululand Kayak Club, club officials as well as sponsors of events, in organising and permitting my participation in such activities and in establishing and enforcing safety measures in regards thereto, cannot ensure my safety/my dependants safety and/or the adequacy of such measures.

3)As such I / my dependants undertake to :

a)Participate in all Kayaking, Diving and associated activities at my own risk and responsibility.

b)Exonerate all persons and indemnify them against loss or damage which I or others, including my dependants, may suffer as a result of any injury or death as a result of any act or omission on the part of such body or person, whether due to negligence (including gross negligence) or otherwise.

c)Comply with all safety rules and regulations of the Zululand Undersea Club / Zululand Kayak Club.

4)I acknowledge that should my membership lapse and my boats(s)/equipment remain on the Zululand Undersea Club / Zululand Kayak Club property, that they may be sold at an auction to defray expenses. Notification of the auction / intended disposal of the equipment will be give via the Zululand Undersea Club / Zululand Kayak Club Newsletter as well as advertised in a local newspaper.

5)I have disclosed all medical conditions/history that I am aware of; e.g. heart condition, diabetes, or allergies (asthma), or injuries (weak joints) that would assist office bearers of the club.

Acceptance of the Indemnity and Waiver
Name / Signature
Email / Tel No
Date / Place

Minor Persons Under 21

1)I, the parent/guardian of the abovementioned person, permit him/her to participate at his/her own risk and responsibility upon the basis and subject to the provisions set out above.

Relation
Name / Signature
Email / Tel No
Date / Place
Witness
Name / Signature / Tel No
Name / Signature / Tel No