Your Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

Please enter a current mobile phone number

(###)

###

####

Have you previously been a member at QCYC within the last 5 years? *

Yes

No

Membership Category *

If you select 'Family' please complete the details for additional family members below. For all other categories, continue to Membership Intentions and Declarations.

Family (2 Adults and family members under the age of 18 years)

Senior (18 years and older)

Intermediate (18 to 29 years)

Junior - under the age of 18 years not in a family membership

Family Member - Additional Adult

First Name

Last Name

Date of Birth

MM

DD

YYYY

Mobile Number

(###)

###

####

Family Member - Child 1

First Name

Last Name

Date of Birth

MM

DD

YYYY

Family Member - Child 2

First Name

Last Name

Date of Birth

MM

DD

YYYY

Family Member - Child 3

First Name

Last Name

Date of Birth

MM

DD

YYYY

Family Member - Child 4

First Name

Last Name

Date of Birth

MM

DD

YYYY

Declaration: Have you ever been asked to resign or been removed from another Yacht Club? (If so provide detail above) *

Yes

No

Declaration: *

I hereby apply for membership of the Queenscliff Cruising Yacht Club and undertake, if elected, to observe and be governed by the Club Rules and By-Laws.

I declare all information supplied is true and correct.

I acknowledge and agree to comply with the rules and expectations of members outlined in the QCYC Handbook 2023-2024

First Proposer. *

First Name

Last Name

Second Proposer

First Name

Last Name

If you are a boat owner, we encourage you to register your boat on the QCYC Register of Boats. This will expedite your bookings and enable reduced wharfage fees.

Yes, I own a boat and will register my boat on the QCYC Boat Register

I do not own a boat