CanSurvive Registration

CANSURVIVE TEAM ONLY
1. Please complete this form to register for this season.
2. Before 20 October 2016, please pay your annual subscription of $150 to: 02-0520-0090409-000 using your name as a reference.
OR forward your payment to: The Treasurer, CanSurvive Dragon Boat Team Inc. PO Box 713, Wellington 6140
This information will not be given to a third party unless it is for the purposes of entering an event.

Registration 2017

* Indicates required field

Name *

First

Last

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Emergency Contact *

Emergency contact phone *

ARE YOU HAPPY TO RECEIVE EMAILS FROM CANSURVIVE *

Yes No

I confirm that I have had a diagnosis of breast cancer *

Yes No

Comment *

Submit

Register Here
for CanSurvive

Registration 2017

Wellington Dragon Boat Team of Breast Cancer Survivors

Register Here​for CanSurvive

Registration 2017

Wellington Dragon Boat Team of Breast Cancer Survivors

Register Here
for CanSurvive