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APPLICATION FOR MEMBERSHIP OF Boating Western Australia

(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

 

 

Signed…………………………….Expiry Date………

Post this form to:

BoatingWA PO Box 692 South Fremantle 6162 Western Australia

For any further information call the secretary on (08) 93353296