Date *

MM

DD

YYYY

Applicant 1 Name *

First Name

Last Name

Phone

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Applicant 2 Name (for Family membership)

First Name

Last Name

Phone

(###)

###

####

Membership Type *

Please pay by direct credit to Bank Account: 01 0137 0026279 00 using your name and ‘new member’ as reference. Pay the 'per annum' sum for applications between 1 June and 30 November. Pay the 'pro-rata' sum for applications between 1 December and 30 May. If your application is not successful, your fee will be promptly refunded to you in full.

Full Individual — $255 per annum / $128 pro-rata

Full Family — $290 per annum / $145 pro rata

Youth — $27.50 per annum / $14 pro rata

Associate Individual (Social) — $165 per annum / $83 pro rata

Associate Family (Social) — $192.50 per annum / $96 pro rata

Proposer *

Must be financial members of DYC at the date of your application.

First Name

Last Name

Proposer's phone number *

(###)

###

####

Seconder *

Must be financial members of DYC at the date of your application.

First Name

Last Name

Seconder's phone number *

(###)

###

####

YOUR PRIVACY *

I consent to DYC collecting the above details for the purpose of DYC club membership records and for DYC to retain, publish in the DYC Handbook, use to communicate with me by Mailchimp DYC email, and disclose to Yachting New Zealand and funding agencies. I acknowledge my right to access and correct this information. This consent is given in accordance with the Privacy Act 2020.