ECCLESTON MERE, BURROWS LANE, ST.HELENS. Royal Yachting
Association & Enterprise Association Affiliated. Membership Application. Title.
Pilkington Sailing Club ECCLESTON MERE, BURROWS LANE, ST.HELENS. Royal Yachting Association & Enterprise Association Affiliated Membership Application Title
Forename(s)
__ Surname _____________________
Address _______________________________Post Code________________ Home Tel _____________Mobile Tel _________________ E-Mail address Family Memberships - please list all family members below. (Use the back of this form if necessary). Forename(s) Surname Relationship (if different from applicant) (to applicant)
Please list below all boats owned by you or your family that will be used at the club:Class Sail Number Boat Name
Date of Birth (if under 18)
Berth Required? YES / NO YES / NO YES / NO
Membership Type
Annual Fee
Family
£190
Adult (Over 18)
£100
Junior/ Student
£50
Social. (Non Sailing)
£5
Compound Fee Beginners Course
No.
Total
£20 per boat
£100
Declaration: All persons listed above agree to abide by all the rules and byelaws of Pilkington Sailing Club. I confirm that my dinghy(s) are insured against Third Party Risk to a minimum of £2,000,000. I accept that membership details are stored in a computer based system. Parents/Guardians are responsible for the safety of young persons under the age of 18 years and must make arrangements for their supervision at all times. Racing: I understand that I may be expected to undertake at least two Race duties each year. Medical Conditions: In order to minimise risk and endeavour to ensure your safety are there any medical conditions you feel we should be aware of, e.g. asthma, diabetes or specific medication? Please indicate in the space below.
Per person
Refresher Course
FOC
to
members
Improvers Course
FOC
to
members
Photographic Material Declaration: I/we consent to my/our name/family name and photographic images being published in club and other publications including the Internet in relation to club news. I/we also consent to photographic and video images of me/my family being displayed at the club and/or used for training purposes. I hereby grant Pilkington Sailing Club full use of these images. Please tick if consent is declined. Signed
Date
Parent or Guardian must sign for junior memberships
I enclose a cheque in the sum of £ Payment can be made by cheque payable to “Pilkington Sailing Club”, please do not send cash, or via Bank Transfer: RBS Acc 12753181 Sort Code 16 30 28. Please notify below if you use this payment method.
Return this form to: Stan Barton. 8 Forest Mead, Eccleston. St Helens. WA10 5BU. For more information, visit our website at www.pilkingtonsailingclub.co.uk or contact our membership secretary Stan Barton, Tel 01744 621116 or email
[email protected].
PSC Use only. Received by:
Date:
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