Select the course you wish to join (required)
---September 2017 CourseNovember 2017 CourseJanuary 2018 CourseFebruary 2018 Course

Your Full Name (required)

Your Address

Your Age

Mobile Number

Your Email (required)

Where did you hear about this course? (required)
---GoogleMurdoch websiteRowing WA websiteSign at the clubTrailer signWord of mouthReferral from MemberFlyer in letterboxOther

Do you have any medical ailments or conditions that we should be aware of that may be affected by rowing? eg. Asthma, Heart conditions etc.

If so, please list them

I am able to swim at least 100m, and I am not suffering from an illness or medical condition, other than declared above, that may put myself or other rowers in danger while rowing / sculling. I agree that I am participating in the sport of rowing at my own risk and whilst all due care will be taken by Murdoch Universtity Rowing Club, I will be responsible for my own safety.

I confirm the above