Kapiti Radio Yacht Club Membership Application

Kapiti Radio Yacht Club

Membership Application and Renewal Form
Type of Application*

This is a new membership applicationThis is an application for renewal
--------------------- Member Details ---------------------
Member Name:*

First NameLast Name
Member Address:*

Address Line1

Address Line 2

Town/CityState / Province

Postal / Zip Code
Member Phone Number:
Member Email Address:
--------------- Emergency Contact Details --------------
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number:
Relationship to Member
-------------------- Membership Type -------------------
Ordinary member subscription includes a $10 annual subscription to NZRYA. This does not have to be paid to KRYC if your NZRYA subscription for the current financial year has been paid by another club.
Membership Type:*

Ordinary Member (incl NZRYA subscription) - $40.00Ordinary Member (excl NZRYA subscription) - $30.00Social Member - $15.00Junior Member - $10.00
Total to pay:
The club paying my NZRYA subscription:*
------------------------ Agreement ----------------------
Consent to NZRYA membership*

I consent to Kapiti Radio Yacht Club joining me as a member of NZRYA.
Agreement to Abide by the Rules*

I agree to abide by the Constitution and Regulations of the Kapiti Radio Yacht Club.
----------------- Subscription Payment -----------------
Pay your subscription to the account of Kapiti Radio Yacht Club at ASB, Paraparaumu, Account: 12-3157-0167988-00.

Please include your name on the lodgement.
Should be Empty: