Individual Membership Signup

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Name*
Date of Birth*
Address*
You must be a permanent resident of your State within our Region. Exceptions must be approved by the Executive Board. You will only be allowed to race at our Regionals Race with your Primary Club. Listing the Paddling Club you are a member of could provide a discount to the Club for their Membership Dues with the SRDBA. Both the Club and Individual Membership forms must be received by March 31st to receive the credit. No exceptions.
Credit Card*
American Express
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MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Expiration Date