Mooloolaba Game Fishing Club Inc.

Membership Application Form


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Personal Details  
Membership Status: New:Renewal:
Payment Type:
Junior: ($35.00)
Senior: ($70.00)
Family: ($140.00)
  • Junior is 15 years or under at the start of the financial year.
  • Family includes a maximum of two adults and up to six juniors.
Person 1 (You, the person filling out this form)
First Name:
Surname:
Date of Birth:
Partners Name:
Home Address:
Postal Address:
Home Phone:
Work Phone:
Mobile Phone:
Fax:
Email:
Occupation:
Nominated By:
Seconded By:
Person 2 (Second Senior Member)
First Name:
Surname:
Date of Birth:
Person 3 (Junior Member)
First Name:
Surname:
Date of Birth:
Person 4 (Junior Member)
First Name:
Surname:
Date of Birth:
Person 5 (Junior Member)
First Name:
Surname:
Date of Birth:
Person 6 (Junior Member)
First Name:
Surname:
Date of Birth:
Person 7 (Junior Member)
First Name:
Surname:
Date of Birth:
Person 8 (Junior Member)
First Name:
Surname:
Date of Birth:

By submitting this form you agree to all the terms and conditions mentioned herein

IMDEMNITY
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.

N.B. Please note- If you own a boat please complete the Safety and Rescue Information form for the Membership Officer to update and cross check information on hand. (THIS IS VERY IMPORTANT FOR YOUR OWN SAFETY)

Safety and Rescue Information (Boat Owners must fill in details)  
Name of Vessel:
Model:
Description:
Registration Number:
Length:
Hull Type:
Hull Material:
Colour-Hull:
Deck:
Superstructure:
Engine/s:
HP:
Fuel Type:
Capacity:
Range:
Speed Crusing:
Max:
Other Pertinent Information:
Insurance Details  
Insurer:
Policy Number:
Safety and Emergency Equipment By selecting a checkbox you indicate that you have this equiptment in full working order.
Radio:
VHF:Brand (if applicable):
27MHz:Brand (if applicable):
HF:Brand (if applicable):
Mobile Telephone Number:
Radar Reflector:
Flares:
EPIRB: Brand (if applicable):
Dinghy:
Life Rafts:
Life Jackets:
Lifebuoys:
Radar: Brand (if applicable):
Range:
Depth Sounder:
G.P.S:
Hand Held Compass:
Food (Number of Days supply):
Water (Number of Days supply):


Total:$.00

 

Copyright © 2006 Mooloolaba Game Fishing Club.
http://www.mgfc.com.au
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