Membership application for new or returning members

Membership Application

Applicant

First Name

Last Name

Address

Street

Town or City including Postcode

Phone

Emergency Contact

Emergency Contact Name

Emergency Contact Phone

Boat Ownership

Registered Hull Number

Boat Name

Boat has Measurement Certificate

Previous Owner [if known]

Main Sailing Venue[s]

Sponsors [2 required]

Sponsor 1

Sponsor 2

Membership Conditions

1. I will abide by the Rules of the Association in its Constitution
2. I am aware of the inherent risks in the Activity Program and
a. accept responsibility for my personal safety and well being, and
b. respect the well being of other members, and
c. accept responsibility for the safe use of my own and the Association’s property.

I accept these conditions

Yes

Subscription

The Annual Membership Fee is $15.00.
Preferred payment method is by direct credit to the Association's Bank Account.
Account Number: 06 0996 0271045 00

Please use your "Your Name" and "CJCOA Subs" as a reference.
Or cash payment to any CJCOA Committee Member (No Cheques Please)

Payment Method

Direct Credit

Cash

Tick if you require a receipt

Receipt Required