Member Registration Membership Application FormBreast Cancer Survivor100.00€Non-Breast Cancer Survivor130.00€Consultant1.00€NextPreviousAccount Setup * Username * John_SmithPlease create a username similar to your actual name eg: JohnSmith or Mary_Jane* Password * Strength: Very WeakPersonal Information * First Name * * Last Name * * Email Address * * Mobile Number * * Emergency Contact Name * * Emergency Contact Number * * Can you confirm you are over 18 years ?YesNo* Are you a breast cancer survivor?YesNoMedical Information Limerick Dragons recommends that you consult your Doctor prior to participating in any/all of the Club’s activities. Do you have any health conditions or take medications which the Club needs to be made aware of before you take up activities? By signing this form you confirm that you will advise the club secretary of any changes in you medication and medical conditions * Please tick any and all that apply?AsthmaDiabetesHigh/ Low Blood pressureLymphedema (incl. at risk)CardiovascularEpilepsyImmune SupressedOtherNoneIf you wish you can use this space to give further information? General Information * Can you swim?YesNo* Have you previous experience in Dragon Boat Paddling and/or kayaking?YesNo* Do you agree to swimming training: 50 meters in a buoyance aid?YesNoHow did you hear about Limerick Dragons? WebsiteWeb SearchFamily & FriendsAdvertisingSocial MediaOtherMembership Membership fees do not cover items outside of dragon boat paddling such as pool aquatics or other exercise classes which the Club may participate in from time to time and for which charges external to the Club would be levied. To complete your membership form you must confirm that you have read and agree to the following: View Safety Statement 2022 View Code of Conduct 2022 View Privacy Statement 2022 View Covid Statement 2022 View Rule Book 2022 * Safety Statement Click to view Safety StatementI Agree* Code of ConductClick to view Code of ConductI Agree* Privacy Statement Click to view Privacy StatementI Agree* Covid StatementClick to view Covid StatementI Agree* Rule Book Click to view Rule BookI AgreeDigital Consent * I understand that if I do not provide my person data my membership will not be processedI Agree* The Club’s activities are organised on Teamer App for the moment and you agree to use this app on becoming a member. I Agree* The Club also utilises a private Facebook and WhatsApp groups and you agree to join this group and monitor for activities and Club notifications. I Agree* You also hereby agree to receive emails and text messages for Club business. I AgreeBy digitally signing this application form I hereby agree to be bound by and comply with the Rules, Regulations, Constitution and Aims of Limerick Dragons and I understand and accept that failure to comply with them may result in my Limerick Dragons Membership being suspended or withdrawn. I give my consent for any photographic and film materials taken of me during activities provided by the Limerick Dragons to be used by the Limerick Dragons in training sessions or promotional material including social media * Digital Signature * By typing your full name you have digitally signed your application formDone(Use Cropper to set image and use mouse scroller for zoom image.) Select Your Payment Gateway Credit/Debit Card (Stripe)Credit/Debit Card (Stripe)How you want to pay?Auto Debit PaymentManual PaymentEnter Coupon CodeApplyPayment SummaryYour currently selected plan : , Plan Amount : Coupon Discount Amount : , Final Payable Amount: Submit
