Registration form Wageningen
Kayak and Canoe Club "De Bovenste Polder"

Please address to :
WKV De Bovenste Polder
Wim Sonneveldstraat 10
6708 NB Wageningen
The Netherlands

I wish to register as a member of the Wageningen Kayak and Canoe Club "WKV De Bovenste Polder".

NAME + INITIALS : ______________________________
CALL NAME: ______________________________
STREET +NR: ______________________________
ZIP CODE + CITY: ______________________________
E-MAIL ADDRESS: ______________________________
TELEPHONE: ______________________________
DATE OF BIRTH: ______________ SEX: M / F*
I DO / DO NOT* wish to hire a place for my own KAYAK / CANOE*.
I DO / DO NOT* wish to make use of a RENTAL CONTRACT for club kayaks.

*Please strike through what does not apply.

If you are also a member of an other kayak club affiliated with the Dutch Canoe Federation (NKB), please fill in the name of the other kayak club and also the NKB membership number:

The undersigned declares:

  1. To be able to swim,
  2. To practise the kayak sport at his/her own risk,
  3. To safeguard the kayak club against the responsibility for any damage to personal properties.

Date: __________________________ Signature: _________________________