Applicaiton

General Info:

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Birthdate *

MM/DD/YYYY

Must be 18+ to row with PLRA

Can you swim? *

Yes No

Inability to swim does not prevent you from rowing. However it will be required that you wear a personal flotation device while on the water.

Do you have any medical conditions that may interfere with rowing? *

Yes No

Emergency Contact Name *

First

Last

Phone Number *

Which session would you like to attend? *

Saturday, May 5, 2018 - 9am-12pm Monday, May 7, 2018 - 6pm-9pm

T-Shirt Size *

Small Medium Large X-Large

How did you hear about PLRA? *

Internet, Referral, Our Ad, etc.

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