Membership Application Form Personal DetailsName *Street Address *Suburb Town Post Code Email *Landline Mobile Any member who is 19 or under at 30 June in this calendar year shall be considered a Youth Member *I qualify as a Youth Member of PRSCYesNo Emergency Contact's DetailsEmergency Contact's Name *Emergency Contact's Phone * Boat[s]Boat Classes Owned iomCanterbury JEC12DF65DF95MarbleheadLaser RCOther Boat[s] OwnedHull Number Sail Number Design Registered YesNoHull Number Sail Number Design Registered YesNoHull Number Sail Number Design Registered YesNo Membership DetailsPersonal Membership of National Association[s] Tick as requiredNZRYACJCOAEC12 Owners AssociationOther Personal Membership of other Clubs Tick as requiredCMYCORYCRYSNCYAOther Membership FeesI require *Full MembershipYouth MembershipNon Sailing Membership Contact our Treasurer for membership fees. Please pay into the club's bank account: 38-9020-0203033-00 with "Member Fee" and "my name" as reference Acknowledgement 1. I will abide by the Rules of the Club in its Constitution and Health and Safety Plan 2. I am aware of the inherent risks in the Activity Program and a. accept responsibility for my personal safety and well being, and b. respect the well being of other members, and c. accept responsibility for the safe use of my own and the club’s property. I accept these conditions *Yes Date * VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank: