OPA Racing

OPA Racing ONLINE

2024

NAVIGATOR

Membership Submission

All members will be required to sign their submitted membership paperwork in person

This form is ONLY to be used for

the position of NAVIGATOR

BOAT NAME / Team Name
*
BOAT NUMBER
*
MEMBERSHIP TYPE
*

Racing Member - Navigator
Position in Boat
Navigator's FULL NAME
*
Navigator's ADDRESS
*
Navigator's EMAIL
*
Navigator's Phone #
*
Navigator's DATE OF BIRTH
*
Date of Last Tetanus Shot
Blood Type
Weight
CURRENT PRESCRIPTION MEDICATION(S)
*
CURRENT OVER THE COUNTER MEDICATION(S)
*
CURRENT SUPPLIMENT(S)/VITAMIN(S)
*
MEDICATION ALLERGIES? IF YES, PLEASE LIST
*
FOOD ALLERGIES? IF YES, PLEASE LIST
*
OTHER ALLERGIES
*
Doctor Name & Number
*
Insurance Company & Policy Number
*
MEDICAL HISTORY
*

HIstory of Seizures
Taking Steroids
Taking Blood Thinners
Diabetic
High Blood Pressure
History of Heart Issues
None Listed are Applicable
ADDITIONAL MEDICAL HISTORY
1st Emergency Contact (CANNOT BE THE PERSON IN THE BOAT WITH YOU)
*
2nd Emergency Contact
*
Credit Card #
Name on Card
Exp Date
CCV Code
Billing Zip Code
Please click on the checkbox to continue
*

MEMBERSHIP fees

Racing Member - $150.00

Driver/Throttleman Registration

Navigator Registration

Non-Racing Crew Registration