VIPCA Vessel Membership Form

Membership Type*

Vessel Point of Contact*

First NameLast Name

Role of Point of Contact*

Email*

Confirmation Emailexample@example.com

Phone Number/WhatsApp*

Country CodeArea CodePhone Number

Website*

Charter or Management Company

Clearing House*

Vessel Name*

Official Number/Registration Number*

Home Port*

Flag*

Vessel Year*

Vessel Make/Manufacturer*

Vessel LOA*

Sail or Power?*

SailPower

Hull type:*

MonoMulti

Maximum Number of Guests*

Number of Crew*

Subscription Date

Date

My Products*

Membership - Day Charter Vessel, Uninspected12pax or under

$200.00 Quantity

Membership - Day Charter Vessel, Inspected13pax or more

$300.00 Quantity

Membership - Term Charter Vessel 42' and below

$300.00 Quantity

Membership - Term Charter Vessel 43' - 56'

$400.00 Quantity

Membership - Term Charter Vessel 57' -79'

$500.00 Quantity

Membership - Term Charter Vessel 80' - 99'

$600.00 Quantity

Membership - Term Charter Vessel 100' and over

$700.00 Quantity

Total

$0.00

Auto Renew Membership?*

YesNo

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.