EMSWORTH CRUISING ASSOCIATION

MEMBERSHIP APPLICATION FORM

Please fill in the boxes. For urgency, use the 'SUBMIT' button below; otherwise, print this form and post with a cheque made payable to:- Emsworth Cruising Association
Applications should be sent to:- Derek Ellinor, 10 Burnham Wood, Fareham, Hants, PO16 7UD.
Applicants should note that there may be delays in processing applications during the summer period as Committee members are likely to be away cruising.

Full Name:
Name(s) of Family/Crew:

Postal address:	Post Code:
	Telephone Nos:

e-mail RYA full member: Yes No
Other Yacht Clubs/Associations:
Boat name       Class type:
Length Overall: x Beam: x Draft:
Vessel moored at: Mooring no:       DSC MMSI (9 digits):
I HAVE THIRD PARTY INSURANCE ON MY BOAT:

                           Signatures & (printed) Names

Proposer/1st supporter: Name:
Seconder/2nd supporter: Name:

Prices
Annual Family Subscription				£
18" Club Burgee	@	£	18.00	£	0 1 2
24" Club Burgee	@	£	24.00	£	0 1 2
1 Motif Club Tie	@	£	10.00	£	0 1 2 3
	TOTAL			£

I would like to join the ECA: Date
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