Your Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

Please enter a current mobile phone number

(###)

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Have you previously been a member at QCYC *

Yes

No

Membership Category *

Select the category for this application. If you choose 'Family' please also fill out the additional members details at the bottom of the form.

Senior (18 years and older)

Intermediate (18 to 29 years)

Family (2 Adults and family members under the age of 18 years)

Junior - under the age of 18 years not in a family membership

Boat Ownership *

Do you own a boat currently?

No

Yes (25 - 35ft)

Yes (35 - 40ft)

Yes (40ft - 50ft)

Yes (50ft+)

If you own a boat, do you intend to register your vessel with QCYC?

Registering your vessel expedites bookings and saves you wharfage fees.

Yes

No

Declaration: Have you ever been asked to resign or been removed from another Yacht Club? (If so provide detail above) *

Yes

No

I acknowledge that it is incumbent upon all members that I am prepared to volunteer to clean and maintain the Club. *

Acknowledged and agreed.

Declaration: I hereby apply for membership of Queenscliff Cruising Yacht Club and undertake, if elected, to observe and be governed by the Club Rules and By-Laws. I declare that the information supplied above is correct.

Agreed and Complete Application

First Proposer. *

We ask that your application is supported by two current members of Queenscliff Cruising Yacht Club (not part of the same family membership). Each member should then complete a Proposer Form, available via the link provided below.

First Name

Last Name

Second Proposer

First Name

Last Name

Family Member - Adult

First Name

Last Name

Member 2 / Date of Birth

MM

DD

YYYY

Member 2 / Mobile Number (If applicable)

(###)

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Family Member - Child

First Name

Last Name

Family Member 3 / Date of Birth

MM

DD

YYYY

Family Member - Child

First Name

Last Name

Family Member 4 / Date of Birth

MM

DD

YYYY

Family Member - Child

First Name

Last Name

Family Member 5 Date of Birth

MM

DD

YYYY

Family Member - Child

First Name

Last Name

Family Member 6 - Date of Birth

MM

DD

YYYY