New-Member-Application

Note

Please ensure that all fields marked with a red * asterisk are completed.

Name*

Title

First

Last

Residential Address*

Street Address City/Suburb State/Territory Postcode

Postal address?*

Postal Address

Street Address City/Suburb State/Territory Postcode

Date of Birth

day

month

year

Email*

Email confirmation*

Home or Main Phone*

Mobile Phone

Occupation/Skill

Partner Name

Emergency Contact*

Emergency Phone*

Select Membership Type*

Associate with Transitional vessel rescue coverage ($50)

Associate without vessel rescue coverage ($20)

1/3

Details

Donation Amount

Note: Donations of $2 or more are tax deductible.

When you click "Pay Now" you will be transferred to the Paypal payment gateway we use. You DO NOT need (or setup) a Paypal account to use a normal credit card. Paypal is simply the secure payment gateway to keep your card details safe.

Total to Pay (incl. GST)

3/3