| 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. |