— RETURN APPLICATIONS TO: P.O. BOX 1843,LITTLE ROCK, AR 72203 —

ARKANSAS CANOE CLUB MEMBERSHIP APPLICATION

Please enroll me as a member in the Arkansas Canoe Club

 Renewal ___ New ___

Name_________________________________ Phone (    )___________________ (hm) (    )_______________________ (wk)

Address_______________________________ City_______________________ State________ Zip Code ________–_________

Email address____________________________________

Chapter      Central ___        Northwest ___        Piney Creek ___         Dust Bowl ___       River Valley ___

Type of membership, please indicate your preference below. 

           ACC  Individual/Family Membership --------------------------------------------------------------------$20.00

           ACC Business Membership – 6 ads published per year - one vote------------------------------------- $75.00

I understand that a certain amount of risk is involved in canoeing, kayaking and related activities, and I agree I will not hold ACC, its officers, or trip leaders responsible for any injuries I may incur while taking part in activities sponsored by the Club.

Signed _______________________________________________________  Date ___________________________________

We encourage all ACC members to join the American Canoe Association at www.acanet.org

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