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SCHEDULE
RESULTS
NEWS
MERCH
RESOURCES
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RACING
MEMBERSHIP
Boat/Team Name
*
Boat Racing #
*
Membership Type
*
Racing Member
Position in Boat
*
Navigator
Additional/Backup Driver/Throttleman
Full Name
*
Email
*
Phone Number
*
Date of Birth
*
Address
*
Year of Last Tetanus Shot
*
Blood Type
*
Weight
*
Current Prescription Meds
*
Current Over the Counter Meds
*
Current Supplements & Vitamins
*
Medication Allergies
*
Food Allergies
*
Other Allergies
*
Doctor Name & Phone 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 is Applicable
Additional Medical History
1st Emergency Contact (Full Name, Phone Number & Relation)
*
2nd Emergency Contact (Full Name, Phone Number & Relation)
*
Payment
*
Pay On-Site
Membership included w/ Team Registration
Item to be charged On Credit Card
Navigator Membership - $200
Racing Membership - $200
Submit
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