Coastguard Whakatane

Application for Membership (Online)

Please complete all applicable fields and check carefully before submitting. You will be sent an invoice for your membership fees. You will not be a member of the Coastguard until your application has been accepted and the fees paid in full.

Applicant	Application Type:
First Names		Surname
Address		Hm ph
Town/City		Mobile
Postcode		Trailer reg
Business Ph		Car reg
email add

Boat
Name		Make
Model		Length
Type		Material
Top Colour		Hull Colr
Propulsion
Type		Mtr type
Motor Make		Model
Main Mtr Hp		Aux Hp
Equipment	(Hold crtl key down and select multiple items if applicable)
Items Carried		Radio/s
		Make
		Call Sign
Contact Details when overdue
First Names		Surname
Address		Hm Ph
Town/City		Mobile
Business ph		Comment
Membership Fees
Ordinary Membership $60 Associate Membership $20 Payment can be made online to: Coastguard Whakatane Bank acc : 03 0490 0168593 00 Or send your cheque to: Coastguard Whakatane PO box 168, Whakatane 3158
By submitting this application I agree to abide by the constitution and rules of Coastguard Whakatane. (Copy held by the Secretary)

Coastguard Whakatane

Application for Membership (Online)

Applicant

Boat

Propulsion

Equipment

Contact Details when overdue

Membership Fees

By submitting this application I agree to abide by the constitution and rules of Coastguard Whakatane. (Copy held by the Secretary)