Membership Subscription - Pohara Boat Club

Name*:

Other Family Members:

Email Address*:

Phone Number:

Mobile Number:

Birthday*:

Gender*:

Ethnicity:

Address:

City:

Post Code*:

Membership Type*:

Please select which membership type your are applying for

Club Donation:

Donation towards re doing the Club deck area

Ramp Card Number:

A $10 fee apply's to new ramp cards.
Please make sure you select the correct membership option from the drop down box.

Trailer Rego:

Required for ALL Ramp Card renewal's.
TDC Requirement.

Membership Type*:

Have you completed all fields on this form?*:

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