Club Membership Form | Sand Yachting.info

Membership

Membership renewal / application *

Renewal of existing membership

New Application for membership

Membership Type *

Single - $50/yr if paid by the 31st July 2020

Family - $75/yr if paid by the 31st July 2020

First Name *

Last Name *

Age *

Adult

Child

Address *

Email Address *

Phone Number *

Permanent Race Number

Partners Details

First Name *

Last Name *

Age *

Adult

Child

Permanent Race Number

Other Family Members

First Name

Last Name

Age

Child under 18 years of age

First Name

Last Name

Age

Child under 18 years of age

Proposer and Seconder for new Members

Proposer First Name

Proposer Last Name

Seconder First Name

Seconder Last Name

Release and Indemnity

Please note:- Fully read Capricornia Blokart Club Inc. rules & regulations, club release and indemnity, and the Blokart Operation Manual before accepting the conditions below (general rules can be found on Blokart website). For safety reasons all financial members are required to wear seat belts, appropriate footwear and helmets during Blokart activities. Adequate operational training for blokart usage has been supplied. CBC members and associates will not be liable for any injury or damage incurred.

Release and Indemnity *

I accept the conditions

Date *

Please enter today's date here

Comments or Questions

How to Pay *

Bank Transfer

Cash

Payment Due

Pay cash to Ian or Paul next time you see them on the beach

Payment Due

Bank of Queensland
Acc Name: Capricornia Blokart Club Inc.
BSB# - 124 001
A/C# - 22259504
Place your name and CBC membership in reference section.

Blokarting on the Capricorn Coast

Partners Details

Other Family Members

Proposer and Seconder for new Members

Release and Indemnity