Southport Yacht Club Membership Application Form

Category:*

Supporter: $150Sailing: $205Intermediate: $150Cadet: $50Related Associate: $75 (spouse of existing Gold Member only)Gold $300 + $1000 Joining Fee

Name*

TitleGiven NamesLast Name

Full Name (incl. Title): *

Date of Birth:*

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

Gold Members only - Please provide a summary of your reasons for joining Gold Membership. i.e. - Intended usage in the Club e.g. Dux Anchorage, Marina, Gym, Yachting – Power or Sail, Board nomination. Please also include any past involvement in SYC and Club activities.

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

Date Signed

Date

ASSOCIATE DETAILS: (Spouse of existing Gold Member)

Full Name (incl. Title):

Assoc. Name

TitleGiven NamesLast Name

Date of Birth :

Date

Residential Address (must match Gold members address):

Contact Phone Number:

Email Address:

example@example.com

Occupation/Company:

Associate Head and Shoulders Photo

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 a designated staff member whom you can contact if you require any clarification on this privacy statement or have a privacy complaint.