APPLICATION FOR MEMBERSHIP
(PLEASE
USE BLOCK LETTERS)
Surname First Names . .
Dr o Mr o Ms o Mrs o
Address.
Postcode
Tel. Home ..Bus . ...
Mobile
Email ..
Do you own a boat? Yes/No oType? .
Are you a mooring licencee/owner? Yes/No o
If yes, what is mooring number(s)? ...
Do you require mooring insurance? Yes/No o (Attach the Mooring application)
Are you a club member? Yes/No o
Which club? ..
DECLARATION
I,
(the applicant) hereby agree to be bound by the Rules and By-Laws of BOATING WESTERN AUSTRALIA INC. upon acceptance by the Committee of my application for membership and I enclose herewith the sum of . ..for my membership.
Signed . ..Date ..
PAYMENT: Cash (in person)o
Chequeo
Credit Cardo
o
o
o
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Signed .Expiry Date
| BoatingWA PO Box 692 South Fremantle 6162 Western Australia |
For any further information call the secretary
on (08) 93353296