Y Canoe Camping Club (YCCC) Registration
National Capital Region YM/YWCA
Please print clearly
1. Name __________________________________________ Phone H ___________________
e-mail __________________________________________ Phone W __________________
Number and Street __________________________________________________________
City ______________________ Province ______________ Postal Code ________________
Additional members must be at the same address. Children under 18 are
free, but must always be accompanied by a parent or guardian.
Name _________________________________________ Phone H ____________________
e-mail _________________________________________ Phone W ___________________
Name _________________________________________ Phone H ____________________
e-mail __________________________________________Phone W ____________________
2. Circle Appropriate Membership Fee
Individual Club Membership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$49
Individual Club Membership for those who have a Y membership . ..$27
2 Person Household Membership . . . . .. . . . . . . . . . . . . . . . . . . . . . . .$77
2 Person Household Membership who have 1 Y membership . . . . . .$68
2 Person Household Membership who have 2 Y memberships . . . . . $49
Each additional Household member . . . . . . . . . . . . . . . . . . . . . . . . . . $44
Each additional Household member who have a Y membership . . . . .$22
3. Make cheques payable to: National Capital Region YMCA-YWCA
4. Please mail:
- This form To: YCCC Membership
- Witnessed Risks and Release form 1-D Castlebrook Lane
- Cheque Ottawa, On, K2G 5E4
