Club Membership Registration Form

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BSB: 633 000 Account Number: 141 274 571 - Tasmanian Jet Sports Boating Club
Single Membership $45.00
Family Membership $60.00
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Member Details* This field is required.
Full Name
Address
Email
Phone
PWC/Boat Licence #
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Next of Kin/Emergency Details* This field is required.
Name
Address
Phone
Relationship:
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Member 1 Details* This field is required.
Full Name
Address
Email
Phone
PWC/Boat Licence #
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Member 1 Next of Kin/Emergency Details* This field is required.
Name
Address
Phone
Relationship:
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Member 2 Details* This field is required.
Full Name
Address
Email
Phone
PWC/Boat Licence #
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Member 2 Next of Kin/Emergency Details* This field is required.
Name
Address
Phone
Relationship:
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Member 3 DetailsSkip If N/A
Full Name
Address
Email
Phone
PWC/Boat Licence #
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Member 3 Next of Kin/Emergency Details
Name
Address
Phone
Relationship:
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Member 4 DetailsSkip If N/A
Full Name
Address
Email
Phone
PWC/Boat Licence #
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Member 4 Next of Kin/Emergency Details
Name
Address
Phone
Relationship:
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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?
YESNO
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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…):
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Health & Safety (Continued)Please provide details of regular medication you take, dosage and frequency:
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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)?
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PWC Details* This field is required.
Make
Model
Year
Rego
Insurance Provider
Policy No:
Comprehensive
Third Party
Type of cover
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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.
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Rules for Membership* This field is required.
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RELEASE AND INDEMNITY* This field is required.
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Where did you hear about us?
A Friend or colleague
Google
News Article
MAST
Website
Marine Dealer
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