Squadron Membership Application Form

Applicant Details

Membership category being applied for?

Title

First Name

Middle Name

Surname

Residential Address

Address Line

Suburb

State

Post Code

Do you have a different postal address?

Yes

No

Postal Address

Address Line

Suburb

State

Post Code

Mobile Number

Email

Date of Birth

Australian Sailing Number (0 if no number)

Car Rego Number

Occupation

Industry

Emergency Contact

Next of Kin Full Name

Next of Kin Relationship to you

Next of Kin Contact Number

More About You

Reason for joining the Squadron?

Do you have any previous yachting or boating experience?

Yes

No

Please provide details of your previous experience here:

Do you have any expertise which you belive the Squadron may benefit from and which you are prepared to assist?

Yes

No

Please provide details here:

Would you like to be further involved with the Squadron as a volunteer? for example Sailing Race Management or assisting Sailability which supports sailing for people with disabilities?

Yes

No

Please provide volunteer areas you would like more information on:

Are you a boat owner?

Yes

No

Vessel Name:

Sail Number:

MAST Registration Number:

Make & Model (e.g "Beneteau 57'):

Vessel Type:

Vessel Most Used For:

Complete for Family Membership - Additional Family Members

please add details of addiational family members.

Additional Family Members

First Name	Middle Name	Surname	Date of Birth	Mobile Number	Email	Australian Sailing Number (0 if no number)	Occupation

Nomination

Do you know any current members of the Squadron who can nominate your membership?

Yes

No

If you don't currently know any members, please continue to complete this form and a Manager will be in touch to get some additional information about yourself to present to the Board.

Proposer Full Name

Proposer Contact Number

How long have you known this person?

Seconder Full Name

Seconder Contact Number

How long have you known this person?

Fees

The following will be used to settle intial Membership fees and will not be held on file.

Our membership year runs from 1 October to 30 September each year. Pro rata membership is available for all new members.

Would you like an access fob? This will allow you access to the marina and amenities block. Each fob has a one off charge of $15.

Yes

No

Names of those to receive an access fob:

Payment Card Number

Expiry Date

CCV Number

Name on Card

I hereby apply for membership of the Derwent Sailing Squadron and if my application is successful, I agree to be governed by the Derwent Sailing Squadron's Constitution, Bylaws and Policies and declare the information provided on this form is true and correct in every particular.

A copy of the constitution and other relevant documents can be requested from the office or via email to admin@dssinc.org.au

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Applicant Details

Emergency Contact

More About You

Complete for Family Membership - Additional Family Members

Nomination

Fees

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