Online Membership Application For New Members

Name *

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Are you a member of any other sailing club?

Yes
No

Do you own a boat?

Yes
No

Membership Type *

Please select Membership type from the dropdown menu.

Spouse Name *

Spouse Email *

Child 1 Name

Child 1 Date of Birth //

Child 2 Name

Child 2 Date of Birth//

Child 3 Name

Child 3 Date of Birth//

Child 4 Name

Child 4 Date of Birth//

Student enrolled full time at:

Date of Birth//

Declaration:

I apply for membership of Wicklow Sailing Club and confirm that the particulars above are correct and all questions answered and appropriate fees will be submitted. It is understood that Parents/Guardians and all members are aware that safety cover is only provided during organized events and members sail otherwise at their own risk. Membership fees do not include mooring or other fees.

Declaration Confirmation: *

I Confirm

Proposers:

Please enter the names of two current members of Wicklow Sailing Club who would be willing to propose your application. If you don't know any members please enter Commodore and Vice Commodore

Proposer 1

Proposer 2

Payment Section:

Please enter your credit / debit card details below

Card Payment Details *

Card

Name on Card