Membership

Membership


Download and complete the Membership Form 2012 or complete your application online below.

Fees are:

Senior Male / Female                                   $80.00 (inc GST)

15 & under (at start of financial year)      $35.00 (inc GST)

Max 2 Adults and 6 Juniors                       $160.00 (inc GST)

I hereby apply for membership to the Mooloolaba Game Fishing Club and submit the following details for your records:

Online Membership Application

Type of Application:

Contact Details

First Name:
Surname:


Person 2 (Second Senior Member)
First Name:

Surname:

Date of Birth



Junior 2 (Second Junior Member)
First Name:

Surname:

Date of Birth



Junior 4 (Fourth Junior Member)
First Name:

Surname:

Date of Birth



Junior 6 (Sixth Junior Member)
First Name:

Surname:

Date of Birth
 Date of Birth

Partner's Name



Junior 1 (First Junior Member)
First Name:

Surname:

Date of Birth



Junior 3 (Third Junior Member)
First Name:

Surname:

Date of Birth



Junior 5 (Fifth Junior Member)
First Name:

Surname:

Date of Birth


Home Address:
Post Code:
Postal Address:
Post Code:
Home Phone:
Work Phone:
Mobile:
Fax Number:
Email:
Occupation:
Nominated by:
Seconded by:
Signature (your full name):
Date:



I acknowledge that I have not been canvassed to join the Mooloolaba Game Fishing Club and that I do so at my own request and volition and at my own risk. I acknowledge that the Mooloolaba Game Fishing Club will not be held responsible at law by either myself, my heirs, successors, executors or assignees for any loss or damage including personal injury, that I may sustain or any damage arising out of my death. Be it under the law under the state of Queensland for the time being or any Commonwealth or International law and I further acknowledge that it is my responsibility to ensure against any such happening and that this application for membership will be pleaded in bar to any such proceedings.


NB Please note - If you own a boat please complete the Safety and Rescue Information on back of this form for the Membership Officer to update and cross check information on hand.


THIS IS VERY IMPORTANT FOR YOUR OWN SAFETY

Name of Vessel:
Model:
Description:
Registration Number:
Length:
Hull Type:

Hull Material:
Hull Colour
Deck:

Superstructure:
Engine:
Horsepower:

Fuel Type:
Capacity:
Range:

Cruising Speed:
Maximum Speed
Other Pertinent Info:


Insurance

Insurer:
Policy Number


Safety and Emergency Equipment

By completing the below, you indicate that you have this equipment in full working order.
Radio: Please check and describe.



SSB HF - Description / Frequencies:
27 mgz - Description / Frequencies:
VHF - Description / Frequencies:

Boat Mobile Telephone:
Radar Reflector:
Flares:
Epirb:


Dinghy:
Life Raft:
Life Jackets:
Life Buoys:


Radar Range:
Depth Sounder:
GPS:
Hand Held Compass:


Food - Number of Days:
Water - Number of Days:
Please calculate your total amount owing: $