You can always press Enter⏎ to continue
23/24 Club Membership Registration Form
1
Can you please write down the following bank account details to make membership payments. You will need to deposit funds into this account to ensure that you membership is valid. BSB: 633 000 Account Number: 141 274 571 - Jetski Tas Inc
*
This field is required.
This is the only way to pay your membership fees, so PLEASE write the bank account details down. Have you written them down????
YES
NO
Previous
Next
Submit
Press
Enter
2
Did you write down the bank account details???? Just in case you never, here they are again. BSB: 633 000 Account Number: 141 274 571 - Jetski Tas Inc
*
This field is required.
Seriously....... please write it down
YES
NO
Previous
Next
Submit
Press
Enter
3
BSB: 633 000 Account Number: 141 274 571 - Jetski Tas Inc
Single Membership $50.00
Family Membership $70.00
Previous
Next
Submit
Press
Enter
4
Member Details
*
This field is required.
Full Name
Address
Email
Phone
PWC/Boat Licence #
Previous
Next
Submit
Press
Enter
5
Next of Kin/Emergency Details
*
This field is required.
Name
Address
Phone
Relationship:
Previous
Next
Submit
Press
Enter
6
Member 1 Details
*
This field is required.
Full Name
Address
Email
Phone
PWC/Boat Licence #
Previous
Next
Submit
Press
Enter
7
Member 1 Next of Kin/Emergency Details
*
This field is required.
Name
Address
Phone
Relationship:
Previous
Next
Submit
Press
Enter
8
Member 2 Details
*
This field is required.
Full Name
Address
Email
Phone
PWC/Boat Licence #
Previous
Next
Submit
Press
Enter
9
Member 2 Next of Kin/Emergency Details
*
This field is required.
Name
Address
Phone
Relationship:
Previous
Next
Submit
Press
Enter
10
Member 3 Details
Skip If N/A
Full Name
Address
Email
Phone
PWC/Boat Licence #
Previous
Next
Submit
Press
Enter
11
Member 3 Next of Kin/Emergency Details
Name
Address
Phone
Relationship:
Previous
Next
Submit
Press
Enter
12
Member 4 Details
Skip If N/A
Full Name
Address
Email
Phone
PWC/Boat Licence #
Previous
Next
Submit
Press
Enter
13
Member 4 Next of Kin/Emergency Details
Name
Address
Phone
Relationship:
Previous
Next
Submit
Press
Enter
14
Health & Safety
*
This field is required.
Do you suffer from any health or medical issues that may affect your riding, ability to safely participate in a ride, or that may affect others on a ride or during any Club activity or do you take frequent medications we should know of in case of emergency?
YES
NO
Previous
Next
Submit
Press
Enter
15
Health & Safety (Continued)
Please provide information about what to do if your health or medical issue arises during a Club activity (eg apply EpiPen, call ambulance…):
Previous
Next
Submit
Press
Enter
16
Health & Safety (Continued)
Please provide details of regular medication you take, dosage and frequency:
Previous
Next
Submit
Press
Enter
17
Health & Safety (Continued)
If you take or carry medications with you during a Club activity, where do you carry it, (eg in your ski or in your ride clothing)?
Previous
Next
Submit
Press
Enter
18
PWC Details
*
This field is required.
Make
Model
Year
Rego
Insurance Provider
Policy No:
Please Select
Comprehensive
Third Party
Please Select
Please Select
Comprehensive
Third Party
Type of cover
Previous
Next
Submit
Press
Enter
19
ACKNOWLEDGEMENT AND AGREEMENT
*
This field is required.
I agree to abide by the Club rules and the Club’s Code of Conduct, as amended from time to time. I agree to follow reasonable instructions given by the Club during Club activities for my safety and that of other participants. I acknowledge that operating any watercraft can be dangerous and if I choose to participate in any Club activities, I do so at my own risk, as do any passengers who accompany me. I have read the Club’s Release and Indemnity and acknowledge it forms part of my application for, or renewal of, my Club membership.
Previous
Next
Submit
Press
Enter
20
Rules for Membership
*
This field is required.
Previous
Next
Submit
Press
Enter
21
RELEASE AND INDEMNITY
*
This field is required.
Previous
Next
Submit
Press
Enter
22
Where did you hear about us?
A Friend or colleague
Google
News Article
MAST
Website
Marine Dealer
Previous
Next
Submit
Press
Enter
Should be Empty:
Question Label
1
of
22
See All
Go Back
Submit