<%@LANGUAGE="VBSCRIPT" CODEPAGE="1252"%> Membership Application Form
Coastguard Eastern Region  
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  Application For Membership   Just complete this application and submit; send no money, we will invoice you.
See Membership benefits, activities and fees
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Predominant Area of Boating:
  Appln Type:
* denotes mandatory field
     
  Name and Address:   Contact Details
  Surname or Company Name *   First Names
  Street Address *   Email Address *
  Postal Address   Occupation
  Suburb/Town*   Home Phone *
  City/Area*   Business Phone
  Post Code*   Mobile Phone
  Country   Radio Callsign
Spacer_100 Boat Details: Space_35 Spacer_100  
 
Boat Name
  Radio Equipment
  Boat Make  
VHF
SSB
  Length ( metres)   Boat Type click only One)
  Engine -hp &,make  
Trailer Boat
Trailer Yacht
Private Launch
Private Yacht
Comm Fishing
Charter Launch
  Life Raft (# persons)  
  Yacht Category   Safety Equipment
  Colour Topsides  
Dinghy
Flares
Life Jackets
Fire Ext
EPIRB
GPS
  Colour Hull/Sides  
            
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