2021 Membership Application Dragonheart Vermont membership runs from Jan 1 - Dec 31.Dragonheart Vermont strives to strengthen and empower breast cancer survivors & supporters through the challenging sport of dragon boating instilling in its members the values of teamwork, fitness & community giving. Questions? Please email [email protected] Step 1 of 2 50% Personal InformationLegal Name* First Last Nickname (optional)Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Cell Phone*Email*Note: We collect your email for membership mailings / newsletters. Please list any special circumstances that coaches and trainers need to be aware of to make a reasonable accommodation for you to safely participate in our fitness programs.Dragonboat paddling is a water activity. I can swim I am CPR certified Upload Your Photo HereWe’ll need a photo ID for IDBF (International Dragon Boat Federation) and ERDBA (Eastern Regional Dragon Boat Association) races. Give us your best selfie from the shoulders up!Annual Membership DuesMembership runs January 1 - December 31Type of Membership*Paddler (VT & Associate) ($150 (Special reduction for members financially impacted by COVID)Paddler (VT & Associate)($225) (If you are comfortable paying the regular membership rate, please do!)Non-Paddler ($100) (You can upgrade to Paddler at any time)Youth (16-18) or Student ($100)Sisters for Life ($10)BCS Metastatic (Free)Lifetime Member (Free)Team Coach (Free)New Veteran (Free)Dues are paid via credit card, in full, by May 15, 2021. A payment plan is available with equal installments due when you renew and then on the 15th of the month for the following three months. NOTE: Membership dues must be paid in full prior to participating in practices or races.TeamsWe collect your birth date and gender for team placement as teams are divided into racing classes by gender and age. Additional race classifications include Breast Cancer Survivor (BCS) and All Cancer Survivor (ACS) teams. Click here to view the different dragon boat racing classifications.Date of Birth*(For team placement) Date Format: MM slash DD slash YYYY Gender*Used for team placement and compliance with USDBF and IDBF policies on single and mixed gender crews.WomanManNot otherwise specifiedSelect any that apply to you: Cancer Survivor Breast Cancer Survivor (BCS) Metastatic BCS Competition Type*How competitive would you like to be? Sport Teams compete nationally/internationally Community teams race locallySportCommunityTeam composition*What type of experience are you interested in? We field both single gender and mixed gender teams in festivals. You may select more than one response. Single Gender Mixed Gender Experience I am a new paddler Do you prefer to paddle*RightLeftEitherNot sureVolunteerismDragonheart Vermont is a non-profit organization and volunteers keep our organization running smoothly and aid us in accomplishing our goals. Please select where you have an interest in helping our organization* Accounting/Finance Boat repair and maintenance Fundraising/Event Planning Photography/Videography Social Media/Marketing Website Design/Maintenance Other Please describe your other area of interest in helping DHVT.LiabilityClick here to read the Dragonheart Vermont Release of Liability.Consent* I agree to the Dragonheart Vermont Release of LiabilityMembership Benefits and Pledge Membership Benefits: Regularly scheduled water practices and workshops (in season) Team and individual dragon boat coaching Team building Use of boats, paddles and butt pads (in season) Eligibility to participate in IDBF races (may have additional costs) Improved endurance and fitness Access to Off Season Training program (additional cost) Community involvement and awarenessAs a Dragonheart Member, I pledge to: Follow the mission of strengthening and empowering breast cancer survivors & supporters throughout the challenging sport of dragon boating. Instill the organization’s core values of teamwork, fitness and community giving. Attend membership meetings and practices regularly. Volunteer at DHVT fundraising and community events. Help the organization maintain the positive energy throughout the membership and community.Agree to the Member's Pledge I agree to the Dragonheart Member's Pledge Emergency Medical InformationYour medical information is made available to your coach/medical personnel and will only be accessed in case of an emergency.Doctor's Name/Practice*Doctor's Phone Number*Date of Last / Status of Tetanus Shot*Date of Last / Status of Wellness Exam*Emergency Contact*Relationship to Member*Contact's Cell Phone*Contact's Alternate Phone (Home/Work)Insurance InformationHealth insurance is not a requirement for participationInsurance Company*Subscriber's Name*Relationship to Subscriber*Group Number*Policy Number*Medical InformationPlease provide medical information that you think is important for us to know in order to assist you in a medical emergency.List of Current MedicationsAllergiesPlease list any other medical information that you feel is pertinent to medical personnel in time of an emergency.Payment and Next Steps After you submit this form, you will be directed to our payment page. If your membership status entitles you to a free membership, just close out of the payment page after that re-direct. Otherwise... Successful registration requires minimum payment of one-fourth of your fees with submission of this form (unless membership fees are less than $25). Dues must be paid via credit card, in full, by May 15, 2021. Optional payment plans require one-fourth to be paid now and the reminder to be paid in equal installments automatically billed to your card on today's date in each of the next three months. You may not participate in practices or races until paid in full. You should receive an email with a copy of this form and a transaction receipt (be sure to check your junk mail if you don't see them promptly).CommentsThis field is for validation purposes and should be left unchanged.
