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Search for:
Home
Our Club
Commodore’s Welcome
Join Our Club
Volunteering
Committee Members
About & History of CYC
Forms & Documents
Newsletters
Our Sponsors
Approved Contractors
On Water
Dinghy
Results
Keelboat
Power Boats
On Water Events
Clubhouse
Bar & Restaurant
Book A Table
Private Functions
Clubhouse Events
Regalia
Marina
Our Marina
Pen Information
What’s On
Contact
Member Login
Home
Our Club
Commodore’s Welcome
Join Our Club
Volunteering
Committee Members
About & History of CYC
Forms & Documents
Newsletters
Our Sponsors
Approved Contractors
On Water
Dinghy
Results
Keelboat
Power Boats
On Water Events
Clubhouse
Bar & Restaurant
Book A Table
Private Functions
Clubhouse Events
Regalia
Marina
Our Marina
Pen Information
What’s On
Contact
Member Login
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Membership Demo
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Membership Demo
Membership Demo
Antoni
2021-02-12T10:21:39+08:00
Demo of Membership form with Pen Application form included
1
Applicant Details
2
Pen & Mooring Details
3
Declarations
Member/Applicant Name
*
Title
Dr.
Miss
Mr.
Mrs.
Ms.
Prof.
Rev.
Title
First
Middle
Last
Prefered Name
If applicable
Date of Birth
*
Day
Month
Year
Home Address
*
Street Address
Address Line 2
City
State
Post Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Postal Address
Same as Home Address
Street Address
Address Line 2
City
State
Post Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Membership Category
*
Please select
Senior 25+
Senior Family
Senior 21-24 yrs
Senior 18-20 yrs
Senior Country
Senior Dinghy 18+
Assosciate Social
Associate Partner
Associate Crew
Associate Reciprocal
Junior Under 15 yrs
Junior 15-17 yrs
Just Friends Inc.
CCGS Old Boys Association
Nor-West Game Fishing Club
Lions Club
Spouse Member Name
First
Last
Reciprocal Club
Reciprocal Member Number
Membership Card
Upload a scan of your current club member card
Drop files here or
Select files
Accepted file types: pdf, jpg, png, Max. file size: 5 MB, Max. files: 5.
Phone
*
Email
*
Next Of Kin Name
Parent Name
*
Next of Kin Phone
Parent Phone
*
Next of Kin Email
Parent Email
Senior Family Member Details
Spouse Name
First
Last
Spouse DoB
Day
Month
Year
Spouse Phone
Spouse Email
Children
Name
DoB
Application Type
*
This application is for...
Pen
Mooring
Not Required
Boating Experience
Interest In Vessel
*
I own the vessel
I am in partnership with my spouse
I am part of a company who owns a boat
I am a partner with a Claremont Yacht Club Member
Member Name
Pen/Mooring Number
Vessel Name
*
Vessel Number
*
Vessel Type
Please select...
Yacht
Power
Model
*
Colour
*
OVERALL SIZES ARE CRITICAL INFORMATION
Overall length includes Bowspit and Swim platform or outbound motors fully raised.
Inaccurate information may result in an incorrect allocation and your vessel may not fit.
Overall Length (m)
*
Overall Beam (m)
*
Overall Draft (m)
*
Special Requirements
DPI Registration Number
*
DPI Registration Expiry
*
Day
Month
Year
M&H Registration Number
Radio Call Sign
*
Radio Mobile Number
*
Do You Require Power?
*
Yes - Permanently
Yes - Intermittently
No
Fuel Type
*
Diesel
Petrol
N/A
Yacht Class
SS22
Div 1/2
Div 3/4
Gaffer
Redwitch
Insurance Details
Insurance Company
*
Insurance Policy Number
*
Policy Expiry Date
*
Day
Month
Year
Pen & Mooring Fees
Pen Fee Payment Option
*
For further information see our
fee schedule
Option 1
Option 2
Option 3
Unsure - Request Contact
Pen Fee Declaration
*
A deposit (Application Fee) of $200.00 is payable on application.
The deposit is interest free to the Club and not refundable if application is withdrawn.
When the Pen is allocated, the deposit is offset against Pen charges.
An Allocation Fee is payable upon allocation of a Pen to a Member.
The Allocation Fee is not refundable, but is held to the member’s credit and is transferable from one pen to another.
The member is liable to pay the difference between the allocation fee originally paid and that applicable to the new pen.
I agree to the disclosed terms & fees or the Pen application process with Claremont Yacht Club
Mooring Declaration
*
Monthly fee: $145
Non-refundable one-off allocation fee: $520
I agree to the disclosed terms and pricing for a Mooring
Prosper & Seconder Details
Proposer Name
First
Last
Proposer Phone
Proposer Email
Seconder Name
First
Last
Seconder Phone
Seconder Email
Membership Declarations
Participation in Club Events & Activies
I intend to become/remain an active Member of the Club and I will participate in the following ways:
Utilizing the Club House Bar/Restaurant
Purchasing fuel
Annual Checkpoint Duty
Power/Sailing Events attendance
Attending Social Events Busy Bees
I may be interested in providing sponsorship to the Club
*
Yes
No
Rescue Boat Donation
*
Annual Contribution to Rescue Boat Donation ($5)
Yes
No
Membership Declaration
*
Participation in Club Events & Activities
I intend to become/remain an active Member of the Club and I will participate in the following ways: Utilizing the Club House Bar/Restaurant, Purchasing fuel, Annual Checkpoint Duty, Power/Sailing Events attendance, Attending Social Events Busy Bees.
Declaration
I declare that all the information I have provided is true and correct. In the event of my formal election to Membership, I will
support the objectives of the Club, abide by the Constitution and the Rules of The Claremont Yacht Club (Inc.) and any regulations
for the time being in force. I acknowledge that I am liable for all unpaid fees and charges incurred by me, and in the event of
default, any debt collection costs incurred by CYC to recover that debt.
I agree to my name, as an applicant for Membership, being posted on the Club’s Members’ Notice Board.
I agree to the declaration
Crew Membership Declaration
*
Participation in Club Events & Activities
I intend to become/remain an active Member of the Club and I will participate in the following ways: Utilizing the Club House Bar/Restaurant, Purchasing fuel, Annual Checkpoint Duty, Power/Sailing Events attendance, Attending Social Events Busy Bees.
Declaration
I declare that all the information I have provided is true and correct. In the event of my formal election to Membership, I will
support the objectives of the Club, abide by the Constitution and the Rules of The Claremont Yacht Club (Inc.) and any regulations
for the time being in force. I acknowledge that I am liable for all unpaid fees and charges incurred by me, and in the event of
default, any debt collection costs incurred by CYC to recover that debt.
I agree to my name, as an applicant for Membership, being posted on the Club’s Members’ Notice Board.
As part of Senior Dinghy & Crew Member categories of membership, In-House Support Scheme Credits are debited to Members accounts at $125 every six months (July & January)
I agree to the declaration
Senior Membership Declaration
*
Participation in Club Events & Activities
I intend to become/remain an active Member of the Club and I will participate in the following ways: Utilizing the Club House Bar/Restaurant, Purchasing fuel, Annual Checkpoint Duty, Power/Sailing Events attendance, Attending Social Events Busy Bees.
Declaration
I declare that all the information I have provided is true and correct. In the event of my formal election to Membership, I will
support the objectives of the Club, abide by the Constitution and the Rules of The Claremont Yacht Club (Inc.) and any regulations
for the time being in force. I acknowledge that I am liable for all unpaid fees and charges incurred by me, and in the event of
default, any debt collection costs incurred by CYC to recover that debt.
The nomination fee is a non-refundable payment.
I agree to my name, as an applicant for Membership, being posted on the Club’s Members’ Notice Board.
As part of Senior Dinghy & Crew Member categories of membership, In-House Support Scheme Credits are debited to Members accounts at $125 every six months (July & January)
I agree to the declaration
Phone
This field is for validation purposes and should be left unchanged.
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