Southport Yacht Club Membership Application Form

Category:*

Supporter: $145Sailing: $195Intermediate: $145Cadet: $50Related Associate: $70 (spouse of existing Gold Member only)
Name

TitleGiven NamesLast Name
Full Name (incl. Title): *
Date of Birth:*

DayMonthYear
Date
Contact Phone Number:*
Email Address*
example@example.com
Residential Address:*
Postal Address:
Occupation/Company:
Are you a boat owner?:
Boat Name:
Boat Type:
Interested in:

Power Boating (please specify)Navigation Rally Events and/orCruising EventsSailing
Do your require an Australian Sailing Number (or your existing ASN to be linked)?
ASN number is required to participate in Club Racing events
Do you know your previous/current AS Number?
if yes please specify
Are you a member of another Club?
If yes, which Club?
Do you have a Proposer?
Proposer name and SYC Card Number:
Name and Card Number
Head and Shoulders Photo
If my application is approved, by sigining below, I hereby agree to subscribe to and be bound by the Southport Yacht Club Inc. Constitution and By-Laws and declare all particulars shown are correct.
Signature of APPLICANT

Clear
Date Signed

DayMonthYear
Date
ASSOCIATE DETAILS: (Spouse of existing Gold Member)
Full Name (incl. Title):
Assoc. Name

TitleGiven NamesLast Name
Date of Birth :

DayMonthYear
Date
Residential Address (must match Gold members address):
Contact Phone Number:
Email Address:
example@example.com
Occupation/Company:
Associate Head and Shoulders Photo
You will be contacted via phone for payment details.
Credit Card Number
Expiry Date
CCV
OFFICE USE ONLY (receipt #, $$, date)
Privacy Act 1988 (Amended 2001) The Southport Yacht Club Inc is committed to the privacy of your personal information such as your name, address, gender, etc supplied by you in your interaction with the Club under the Privacy Act. Southport Yacht Club Inc will use the information to provide its facilities and services to you and also plan new services and improve existing ones. The Club will only collect your personal information that is necessary for us to meet or fulfil our activities and functions. If you choose not to give the required information, your request to join the Club and access to Club facilities and services may be denied. The Club will seek your consent before releasing your personal information, where lawful and practicable and will only disclose your personal information to a third party and for secondary purposes to the extent provided by the Privacy Act. The Club will put in place appropriate measures to safeguard your personal information. You have the right to know what type of information is held about you by the Club and also the right to access and correct your personal information. The Club has adesignated staff member whom you can contact if you require any clarification on this privacy statement or have a privacy complaint.

Membership Payment*

AUDMembership 2025

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

ABN 98 569 906 907 | 1 Macarthur Parade, Main Beach 4217 |+61 7 5591 3500

www.southportyachtclub.com.au
Should be Empty: