East Antrim Boat Club

Membership Application Form

Please Complete In BLOCK CAPITALS
FULL NAME  
Address

 

   Post Code
DOB

Occupation
Phone Home                                                                 Mobile
e-Mail Address  
Type of Membership

If family please give the following details for all included
Spouse/Partner Full name
Date of Birth
Children

 

 Forenames Dates of Birth

Boat Owned

  
Boating Experience

 

  
Boating Interest Racing Cruising
Membership of other Clubs  
Proposed By

 

 Print Sign
Seconded By

 

 Print Sign
Date   Sign  

For office use only
On Board Date Sent  
Date Interviewed Date Paid  
Date Approved Date Card  

Send to :- Honorary Secretary, East Antrim Boat Club, 82 Bay Road, LARNE, BT40 1DG