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Dinghy Storage Application Form

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Annual dinghy storage (May to April) *

Non-Participating Member

Unit Price$344

Qty.

Ext. Price

Participating Member

Unit Price$172

Qty.

Ext. Price

Applicant Details

Full Name of Applicant *

HYC Member Number *

Date of Birth *

Phone *

Email *

Home Address *

City

State/Province

Post Code

Postal Address (If Different to Residential)

City

State/Province

Post Code

Boat Details

Australian Sailing Number *

Club

Sail Number *

Boat Name *

Boat Class *

Emergency Contact

Emergency Contact Name *

Emergency Phone Number *

Declaration & Payment

Today's Date *

Total

I would like to pay by *

Paypal

Credit Card by phone

Member Account

In person at the Club

Declaration & Payment (if required) *

I accept (I declare that the information set out herein is true and correct. By submitting this form, I consent to my details being stored by Hillarys Yacht Club only and I consent to receive relevant electronic communications and documents via email. If dinghy storage payment is required it will be added to your account balance or you will be invoiced or you will be contacted by Club Admin.)

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