Boat Membership Application Form

Last Names

Home Phone

Residential Address

Alternate Contact Person (such as next of kin)

First Name

Date of Birth

Mobile Phone (that will be carried on boat with you)

Postal Address

Phone Number For Alternate Contact Person

Holiday Address - fill this out if you maintain a holiday residence, caravan or utilise camping areas

Name of Boat

Registration Number

Material (fibreglass, aluminium etc)

Type of Boat (centre console, half-cabin etc)

Engine (number, make, horsepower)

Call sign (alternative call sign if used)

Make and Model

Colour

Fuel Capacity (litres)

Boat Length

Upload a photo of your boat, if you have one

Photo

Aux Motor Fitted?

Type of Radio Fitted

Trailer Rego

Vehicle Make

Vehicle Rego

Vehicle Colour

Launch Area (Jurien Bay Marina, Cervantes, Green Head etc)

Marina Pen Number

Any additional information that may be relevant

800

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