Your Name
Your email address
Date of birth
Address and postcode
Telephone (day)
Telephone (evening)
Telephone (mobile)
Please provide name and telephone number of a person you would wish us to contact in the unlikely event of an emergency
Please give details of any medical condition (e.g. asthma, epilepsy). This will not exclude you from participating, but it is important that instructors are aware of any medical condition that may affect your safety.
Please indicate which taster session you wish to attend.
Registration *
 I would like to register for a Regents Canoe Club taster session. I declare that the above information is correct and that I have paid the course fee of £12. 
Participation Statement *
 I have read, understood and agree with the statements in the Participation Statement at http://www.regentscanoeclub.co.uk/tasters.html.  
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