Application for 2010 membership

Applicant Information

Entrance fee (Family & Senior -€150.00 per year for 1st 2 years) 

Name:

Name of spouse:

Current address:

Occupation:

Home Phone No.:

Mobile Phone No.:

Email address:

Category of membership    (Please circle)

Family: €300.00[1]

Senior: €225.00[2]

Associated:   €60.00

Crew:    €120.00 (per annum max 2 years)

Junior:       €60.00

Student:    €90.00

Are you a member of any other club, sailing or otherwise:     Yes          No         (Please circle)  

Name of Club(s)

May we phone for a reference if necessary:  Yes      No

Contact phone no :

Boat Details

Type of boat (if any):

Where is it lying:

Is it intended to base the boat in Wicklow:

Family Membership

State name and dates of birth of children under 18 years of age on 1^st January last.

Name:

Date of birth:

Name:

Date of birth:

Name:

Date of birth:

Name:

Date of birth:

Junior membership   (Under 18 years on 1^st January last)

Name:

Date of birth

I the undersigned Parent/Guardian of the applicant, consent to this application and confirm that the particulars given are correct.

Signature of Parent/Guardian:

Date:

Student membership

Name:

Date of Birth:

I am in Full time attendance at

I apply for membership of Wicklow Sailing Club and confirm that the particulars above are correct and all questions answered and appropriate fees have been submitted.  It is understood that Parents/Guardians and all members are aware that safety cover is only provided during organized events and members sail otherwise at their own risk. Membership fees do not include mooring or other fees. 

Signature of applicant:

Date:

We the fully paid senior members propose and second the above applicant for membership and have received the appropriate fees

Proposer of applicant:

Print name:

How long have you known applicant

Seconder of applicant:

Print name:

How long have you known applicant

Date:

Receipt no :