Membership Form

Please fill out the following form and submit. On the following page you will have the option of paying for your membership.  If you have any questions about this membership application, please email info@kansaswhitewater.org

Membership Options

(payment made on next page)

  • $20.00 Single Membership

  • $25.00 Family Membership

  • $45.00 Associate/Business Membership

  • $200.00 Lifetime Membership


Member Information
First name
  
Last name
  
Family Member's names
  
Address
City
 State

Zip code
 Email
Home Phone
  		 Cell Phone
  
Work Phone
  		  
KWA Newsletter by email
Emergency Contact Information
Contact  name
  
Contact address
City
 State
Zip code
  
Phone
  

(Payment made on next page after submit)