MEMBER INFORMATION

NAME:

BOATER STATUS: Private    Commercial

ADDRESS:

CITY: STATE: ZIP:

HOME PHONE:

CELL PHONE:

WORK PHONE:

E-MAIL:

LEVEL OF MEDICAL TRAINING:

NUMBER OF RAFTS:

NUMBER OF KAYAKS:

NUMBER OF CANOES:

NUMBER OF OTHER:   TYPE:

MAJOR FIRST AID KIT: Yes   No

FULL RIVER KITCHEN:  Yes   No

APPROVED TOILET: Yes   No

FIREPAN: Yes   No

FAVORITE STRETCH:

AREA OF INTEREST (Check all that apply):

President

Secretary

Treasurer  

Organizing Committee

Incorporating Committee

GRA Website

GRA Database

GRA Media Relations

GRA Gear Trader

Tamarisk Control

River Clean Up

Other / Specify