Family Membership - Mad City Paddlers

Membership for a Family – up to 5 accounts

Name:*

First Name Required Last Name Required

Address Line 1:* Address Line 1 is Required

Address Line 2: Address Line 2 is not valid

City:* City is Required

Country:* Country is Required

State/Province:* State/Province is Required

Zip/Postal Code:* Zip/Postal Code is Required

I agree to the terms and conditions of the 2023 Insurance Waiver - https://madcitypaddlers.org/resources/Documents/waivers/2023_mcp_prm_waiver.pdf*

Emergency Contact Name: Emergency Contact Name is not valid

Emergency Contact Phone: Emergency Contact Phone is not valid

Email:* Invalid Email

Password:* Invalid Password

Password Confirmation:* Password Confirmation Doesn't Match

Password Strength Password must be "Medium" or stronger

Pay In Person

No val Please fix the errors above

$15

	Family Membership – Initial Payment $15	$15.00
	Total	$15.00

Family Membership – Initial Payment

$15

$15.00

Total

$15.00