I hereby submit the following information to the Executive Committee of the DALLAS ROWING CLUB for the purpose of being accepted as a member on the following basis:

(CHECK ONE):

JUNIOR_________ REGULAR (single)_______ YOUTH__________

If YOUTH, please indicate name of school_________________________

FAMILY (spouse, and all children under age 18)__________

DATE:_____/_____/_____ DATE OF BIRTH:_____/_____/_____ SEX:_____M _____F

HEIGHT:_____________________________ WEIGHT:_____________________________

NAME:_______________________________________________________________________

HOME ADDRESS:______________________________________________________________

CITY:___________________ STATE:_____________ ZIP:________________

PREFERRED MAILING ADDRESS:_________________________________________________

_____________________________________________________________________________

HOME TELEPHONE: (_____)-_______-________ MARITAL STATUS:_______S______M

COMPANY:_______________________________ POSITION:_______________________

CITY:____________________________________ ST:______ ZIP:________________

BUSINESS PHONE: (_____)-_______-________ FAX: (_____)-_______-________

EMAIL:__________________________________

HEIGHT:_____________ WEIGHT:______________ SPOUSE NAME:____________

CHILDREN – NAMES & AGES:____________________________________________________

EMERGENCY CONTACT:_______________________ PHONE: (_____)-_______-________

ADDRESS: ______________________________ ST:_____ ZIP:________________

PREVIOUS ROWING EXPERIENCE, if any:__________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

YOUR ASSESMENT OF YOUR CURRENT SWIMMING ABILITY(Club requires certification of basic swimming abilities- e.g. YMCA certificate):_______________________________________

DESCRIBE YOUR CURRENT LEVEL OF EXERCISE ACTIVITY DURING THE PAST 12 MONTHS:____________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

DESCRIBE ANY PHYSICAL IMPAIRMENTS THAT YOU MIGHT HAVE:___________________

_____________________________________________________________________________

ARE YOU ON ANY SPECIAL MEDICATION? (describe and give name & address of your physician):____________________________________________________________________

DESCRIBE ANY SPECIAL SKILLS OR INTERESTS THAT YOU HAVE:___________________

_____________________________________________________________________________

GIVE ANY ADDITIONAL INFORMATION THAT YOU FEEL IS PERTINENT TO THIS APPLICATION (ie. HIGHSCHOOL AFFILIATION, if youth memeber):

_____________________________________________________________________________

_____________________________________________________________________________

NAME OF DRC MEMBER THAT HAS CHECKED YOU INTO A BOAT LEVEL:___________________

_____________________________________________________________________________

(Note: Youth Members are to be checked out by Jon Werner only)

NAMES OF ANY CURRENT CLUB MEMBERS THAT YOU KNOW:_______________________

_____________________________________________________________________________

I hereby apply for membership to the DALLAS ROWING CLUB and submit the above information as a meter of record concerning my membership. I agree to abide and comply fully with the By-Laws of the Club and any and all rules and regulations imposed on Club members. I understand that membership is on an annual basis in accordance with the current Club membership policies and I submit with this application my check#_______ in the amount of $________ as payment for membership dues on the following basis (i.e.annual, trimester, etc):________________________________. I understand that my membership begins upon acceptance of same by the Membership Chairman and Executive Committee of the DALLAS ROWING CLUB. Access to the Club facility and use of Club equipment is limited to current dues-paying members only. I agree to pay the Club dues, assessments, rents and other legitimate charges to my account within 10 days of notice of charges.

Signed this ____________ day of ________________ 2001 for the purpose of applying for membership to the DALLAS ROWING CLUB.

SIGNATURE:________________________________________________________________________

PRINT NAME:_______________________________________________________________________

For this application to be considered, it must be accompanied by a check for dues and a signed and dated current RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND IDEMNITY AND PARENTAL CONSENT AGREEMENT ("AGREEMENT)

Mail completed application to : Membership Chairman, DALLAS ROWING CLUB, P.O. Box 7309, Dallas, TX, 75209,
or place completed application in the mailbox marked 'Secretary', on the upper level of the boathouse.

Upon acceptance, you will be given a membership card with access to the Club facilities and assigned a LEVEL for use of club owned equipment. The LEVEL is determined by the Club based on the Club's assessment of your current rowing abilities.