RENEWAL OF 2010 WICKLOW SAILING CLUB membership

MEMBER(s) Information UPDATE FORM

Name (1):

Spouse/Partner (2):

Current address:

Occupation (1):

Occupation (2):

Home Phone No.:

Mobile Phone No.(1):

Email address(1):

Work Phone No.:

Mobile Phone No.(2):

Email address (2):

Please tick here if you do not wish to receive updates regarding Sailing or Social events in Wicklow Sailing Club  ___

Type of membership    (Please circle)

Family:

Senior:

Family >65 (>8yrs in WSC)

Senior >65 (>8yrs in WSC)

Associated:  

Crew (2 years only)

 Student:   

 Junior <18

Boat Details

Type of boat (if any):

 Name:

 LOA:                          Draft:

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:

Name:

Date of birth:

Name:

Date of birth:

Additional Relevant Information (if any):

I/we the undersigned confirm the amended details above and wish to renew my/our membership for 2010.

I /we enclose payment in the amount of € ________  by cheque / cash / credit card (circle as appropriate)

Signature of member (1):  _______________________________________________________     Date ____________

Signature of member (2):  _______________________________________________________     Date ____________