Prepaid Membership FormPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Membership Type *Senior Membership - $100.00Junior Membership - $35.00Family Membership - $200.00New Member DetailsName *FirstLastAddress *Address Line 1Address Line 2CityState / Province / RegionPostal CodeEmail *Mobile *Date of Birth *Family DetailsAdult 2 *FirstLastAdult 2 - Email *Adult 2 - Phone *Adult 2 - Date of Birth *How many Junior's would you like to join?123456Junior 1 - Name *Junior 1 - Date of BirthJunior 2Junior 2 - Date of BirthJunior 3Junior 3 - Date of BirthJunior 4Junior 4 - Date of BirthJunior 5Junior 5 - Date of BirthJunior 6Junior 6 - Date of BirthWould you like to add another member?YesNo, I'm doneAdditional Member DetailsAdditional Membership Type *Senior Membership - $100.00Junior Membership - $35.00Name *FirstLastAddressAddress Line 1Address Line 2CityState / Province / RegionPostal CodeEmail *Mobile *Date of Birth *Would you like to add another member?YesNo, I'm doneAdditional Member DetailsAdditional Membership Type *Senior Membership - $100.00Junior Membership - $35.00Junior must be 15 years or under on June 30.Name *FirstLastAddressAddress Line 1Address Line 2CityState / Province / RegionPostal CodeEmail *Mobile *Date of Birth *Boat InformationFor your safety and insurance purposes, please complete the following information about your vessel.Do you own a boat? *YesNoName of Vessel *Make and Model *Length *Registration Number *Insurance Company *Policy Number *Hull TypeHull MaterialHull ColourDeckSuperstructureEngine/sH.PFuel TypeCapcityRangeCruising SpeedMax. SpeedRadio - SSB HFRadio - 27 mhzRadio - VHFPlease indicate which resources you have on board in case of an emergency. *Radar reflectorFlaresEPIRBDinghyLife raftsLife jacketsLifebuoysRadarDepth SounderGPSHand-held compassImdemnityImdemnity *I acknowledge terms and conditions outlined below. *By ticking this box, I acknowledge that I have not been canvassed to join 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.Submit
