Membership Form

MEMBERSHIP FORM
2015 – 2016

NAME*:_______________________________

POSTAL ADDRESS*:____________________

SUBURB*: ____________________________

POSTCODE*:__________________________

DATE OF BIRTH:  __ /___ /______

SAIL NO. __________

SEX*: MALE / FEMALE

PROPOSED SAIL NO.
OPTION 1:  ___________    OPTION 2: ____________    OPTION 3:____________

EMAIL*:__________________________________________

PHONE* (H):(03)_____________   (W): (03)_____________   (M):_______________

MEMBERSHIP * --- 1 July 2015 to 30 June 2016

Membership includes: access to competitions in Victoria & nationally, public liability insurance during organised events via AWA, sail number registration and much more! Refer to AWA website for more details on the sports insurance policy www.windsurfing.org/insurance.
Please note; WV membership fees help to cover WV ongoing yearly costs (e.g. AWA insurance, equipment for the Teach a Mate extended program, events, trophies, marketing, etc).
Membership Options:

  • Standard $40 Pensioner/Full-Time Student (up to 25) $30
  • Names of Additional Family Members @ $20 each

WV Volunteer*
Would be able to help out as WV Volunteer at a WV event during the season?     Yes / No


PAYMENT (Please mark one) *

  • EFT – PayPal (Visa/MC)
  • Cash
  • Cheque

EFT Commonwealth Bank Acc Name Windsurfing Victoria BSB 063550 Acc no. 10236618
PayPal Payments can be made via the Windsurfing Victoria website on the membership page.
Select the type of membership and follow the PayPal cart buttons.

Credit Card If PayPal cannot be made, please complete the following to authorise Windsurfing Victoria to complete the payment for you.

NAME ON CARD INITIAILS:_________________________

CARD NO. EXPIRY DATE:____________________________

SECURITY CODE (last 3 numbers on signature strip):___________________

AMOUNT: $_________

SIGNATURE * ____________________________

DATE *___/____/______


PARENT?S SIGNATURE (if under 18):____________________

Send to: WINDSURFING VICTORIA
Mail: 221 Esplanade West, Port Melbourne, Vic 3207
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Windsurfing Victoria Inc. ---- Reg No. A0049214P ABN 59 441 540 713