Membership Application Form

• 1) Personal Details
• 2) Membership Type
• 3) Review & Declaration
• 4) Insurance Policy
• 5) Payment
• 6) Finish

* Mandatory fields

• My Details

  Title - select Title -

  Date of Birth (DD-MM-YYYY)
  First Name ^*

  Middle Name

  Surname^*

  My Primary Contact Details

  Primary Email Address (for username)^*

  Re-enter Primary Email Address^*

  Primary Phone/Mobile number (no space)^*
  Alternate Email Address

  Please enter at least one mobile or phone number.

  Please enter phone number.

  Primary Phone Number^*(no space or special characters)
  Address line 1 ^*

  Address line 2

  Suburb ^*
  State^* - select state -

  Postcode ^*

  Country - select country -
  Email or Snail Mail preference ^* Email     Snail Mail

  My Boat Details

  Boat Operator Licence No ^*

  Expiry Date ((DD-MM-YYYY) ^*

  Licence State^* - select state -

  MAXIMUM BOAT LENGTH (21') FROM MANUFACTURE'S SPECIFICATION SHEET

  Boat Registration No ^*

  Expiry Date (DD-MM-YYYY) ^*
  Description of Boat/ Jet Ski (Brand/model) ^*
  Boat Name

  Engine Size/Type ^*

  Engine Size/Type ^* Inboard     Outboard
  Boat Trailer Registration ^*

  Boat Length (Maximum 21') ^* - select Boat Length -

  3^rd Party Insurance Cover

  Insurance Company Details ^*

  Policy No ^*
  Expiry Date (DD-MM-YYYY) ^*

  Water Skiers Liability Amount ^*(min $1,000,000 only accept numeric character)

  My Interests

  My Family Members

  Spouse/Partner
  Children (under 18 years)

  Opt In

  Opt in to receive emails from BVWSC

  I would like to receive email notifications including news and event updates.
  Next

• List of Annual Fees

  Membership Fee
  CCMA Permit Fee
  Key Deposite fee
  TOTAL FEE

  Tick this box if you are a Geelong WSC Member and already have a CCMA permit number for the current season (CCMA Permit Fee is not required)

  If you are a Geelong WSC member, please enter CCMA Permit and Membership No

  CCMA Permit No

  Geelong WSC Membership No

  Membership Fee (based on the above selection)

  Membership Type

  Member

  Total Annual Fee

  $180

  Previous Next

• Please confirm the following details:

  My Details

  Title

  Date of Birth (DD/MM/YYYY)

  First Name ^*

  Middle Name

  Family Name ^*

  My Primary Contact Details

  Primary Email Address^* (this is used for Login username)

  Alternate Email Address

  Primary Phone/Mobile number^*

  Primary Phone Number^*

  Address line 1 ^*

  Address line 2

  Suburb ^*

  State^*

  Postcode ^*

  Country

  Email or Snail Mail preference ^*

  My Boat Details

  Boat Operator License No ^*

  Expiry Date ^*

  Licence State^*

  MAXIMUM BOAT LENGTH (21') FROM MANUFACTURE'S SPECIFICATION SHEET

  Boat Registration No ^*

  Expiry Date ^*

  Description of Boat/ Jet Ski (Brand/model) ^*

  Boat Name

  Engine Size/Type ^*

  Boat Trailer Registration ^*

  Boat Length (Maximum 21') ^*

  3^rd Party Insurance Cover

  Insurance Company Details ^*

  Policy No ^*

  Expiry Date ^*

  Water Skiers Liability Amount ^* $

  My Interests

  My Family Members

  Spouse/Partner

  Children (under 18 years)

  Opt In

  Opt in to receive emails from BVWSC

  List of Annual Fees

  Are you a Geelong WSC member?

  CCMA Permit No

  Geelong WSC Membership No

  Membership Fee (based on the above selection)

  Membership Type

  Total Fee Amount $

  Declaration

  The Barwon River is a natural river with banks lined with trees and other potential obstacles, both natural and man made, such as, retaining walls/posts, boat docks, bridge pylons, water pipes etc. It is the responsibility of each skier to become aware of the surroundings and take due care when involved in any water-ski activities. Each person uses the river at his or her own risk and therefore neither the Barwon Valley Water-Ski Club Inc. nor Corangamite CMA will be held liable for any accidenct that may occur.All persons operating a vessel on the Barwon River are required to hold a current licence to operate that vessel, as required by Victorian Boating Laws.

  I have read and agreed to abide by the rules of the Barwon River and the Barwon Valley Water-Ski Club.

  If the details above are correct, please click NEXT, if you would like to update any details, please click PREVIOUS. You cannot change these details after you click the NEXT button.

  Print     Previous NextPlease wait while directing to payment page. You can also upload your insurance policy.