NWIPA

After you click ‘Submit Form’ below you will be directed to the payment page to select and pay for your membership type.

Once your registration and payment have been received you’ll receive an acknowledgement including your membership number and a welcome letter detailing your membership benefits sent to the email address you entered on this form. This may take a few days.

Thanks for supporting the Northwest Indiana Paddling Association.

First Name *

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Emergency Phone *

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In the unlikely event of an emergency while participating in an NWIPA event, please provide emergency contact information *

Contact Name *

Middle Name

Last Name *

Email *

Address Line 1 *

Address Line 2

City *

State *

Zip/Postal Code *

Home Phone *

Mobile Phone *