HACKS MEMBERSHIP APPLICATION

NAME ____________________________________________________________

ADDRESS _________________________________________________________

CITY _________________ STATE ____ ZIP _________ PHONE ____________

E-MAIL ___________________________________________________________

May we put your name and address in HACKS Directory? YES ____ NO ____

TYPE OF MEMBERSHIP (PLEASE CHECK ONE)
Regular _____ $10.00
Family _____ $25.00
Contributing (includes T-shirt) _____ $30.00 S M L XL XXL
Supporting (includes T-shirt, lots of prestige) _____ $50.00

CLOTHING
World-famous HACKS T-shirt (circle size) S M L XL XXL ______ $12.00
Short-sleve HACKS Paddle jacket (circle size) S M L XL XXL ______ $35.00

AREAS OF INTREST (CHECK ALL THAT APPLY)
RIVER CRUISING Closed Boat ____ Open Boat ____
Class I ____ Class II ____ Class III ____ Class IV ____ Class V ____
SLALOM RACING Closed Boat ____ Open Boat ____
DOWNRIVER RACING Closed Boat ____ Open Boat ____
SQUIRTING ____ HANGING OUT AND LOOKING COOL ____
VOLUNTEER ____ ?
RACES ____ JUNIOR PROGRAMS ____ FUND-RAISING ____

Please send check and membership form to:
ANN LECLAIR
BRAYTON PARK
OSSINING, NY 10562-3201
Any questions, please call Ann at: 1-914-941-4286 (9:30 AM to 6:00 PM)
E-Mail: ann@theleclairs.org 1-914-762-5121 (24Hr Answer Machine)
Members are valid through the end of the calender year.
New memberships received after September 1st will be valid through the end of the following year.

This form was printed from the HACKS internet web site.




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H-MEMBER - Updated: 02/07/2008