Membership Renewal

Member Number*

Name*

Title

First

Last

Email*

Has your residential or postal address changed?*

Yes

No

Residential Address

Street Address City/Suburb State/Territory Postcode

Postal address?*

Postal Address

Street Address City/Suburb State/Territory Postcode

Have any of your phone numbers changed?*

Yes

No

Home or Main Phone*

Mobile Phone

Have any of your contact details changed?*

Yes

No

Partner Name

Emergency Contact*

Emergency Phone*

Select Membership Renewal/Change Type*

Associate/ordinary membership with single vessel rescue coverage ($88)

Associate/ordinary membership without vessel rescue coverage ($20)

Family Membership with single vessel rescue coverage ($98)

Family Membership NO rescue coverage ($31)

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Details

Donation Amount

Note: We are a 100% volunteer organisation and your donation helps us maintain safety on the water. All Donations of $2 or more are tax deductible.

Total to Pay (incl. GST)