Membership Application / Renewal Please fill in the form below to apply / renew your Little Ship Club Membership. "*" indicates required fields Members DetailsAre you an existing member?* Yes No Membership No.Name* Title Dr.MissMr.Mrs.Ms.Prof.Rev. First Last Address* Street Address Suburb State Postcode Mobile*PhoneEmail* Date of Birth DD slash MM slash YYYY Vessel DetailsVessel NameLengthType of Vessel Power Boat Sail Boat Vessel Insured byPolicy NumberMembership DetailsMembership PricingMembership Type* New Full Member ($330) + Building Levy ($50) Renewing Full Member ($330) + Building Levy ($50) Senior Member* ($165) + Building Levy ($50) Existing HLM/Fully Paid Member Building Levy ($50) Associate Member 1** ($20) Associate Member 2** ($20) Social Member ($10) Optional Extras Security Fob ($40) LSC Small Burgee (vessel <13m) ($45) LSC Large Burgee (vessel > 13m) ($65) LSC Stubby holder ($10) + freight ($5) LSC Cap ($35) + freight ($12.50) LSC T-shirt ($42) + freight ($18) * Senior members need to have been a member of the club for 15 years or more and be aged over 65 years old. Associates must be attached to a full or senior membership. Members security fobs are for full, senior and associate members only. Please select T-Shirt Size* S M L XL 2XL 3XL 4XL Total Payment Options* Pay by credit card online (redirected to Paypal) Pay via bank transfer Pay by credit by calling Club Bank Transfer Details BSB: 124 017 ACC# 22848152 PLEASE PROVIDE SURNAME AND MEMBER NUMBER AS A REFERENCE.CAPTCHANameThis field is for validation purposes and should be left unchanged.
