Membership Application Form

Details

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Are you attending this event?

Yes No Maybe

First name*

Last name*

Phone number*

Email address*

Address*

Fields marked with an asterisk* are mandatory.

All members need to provide this information, so we collect it now to save doing it later.

Date of Birth*

Gender identity*

Emergency contact name*

Emergency contact phone*

Australian Sailing Number (if any)

Membership category*

Give a brief summary of your sailing experience* Max. 255 characters

Class(es) sailed currently

Do you need boat storage? Note: storage is subject to availability. Contact the Club Captain to enquire.

Qualifications held

Marine Licence

Powerboat Handling Certificate

Safety Boat Operator

Assistant Instructor

Instructor

Race Officer

Responsible Service of Alcohol (RSA)

Working with Children Check

First Aid Certificate

Anything else you'd like to add Max. 255 characters

I am over 18, or, if I am under 18, this registration has been filled out by and endorsed by my parent or guardian.*