Name and Address:

Type of Membership requested (please select):

Date of birth:

Email:

Phone Number:

I AM / AM NOT happy to share my phone number with other members of the club (delete as applicable)

Next of Kin / Parent or Guardian:

Name and Address: 

Next of Kin / Parent or Guardian Phone number:

Relationship:

Reasonable adjustments required for disability or other condition:

Boat details (if applicable):

Mooring required (please select):

Name or Number

Model / Class

Length (in feet)

Draught (in feet)

Co-owner (if applicable)

In applying for membership and signing this policies of Thurrock Yacht Club. form, I will abide by all rules, bylaws and policies.

Signed:

Date: