Boat Registration Form

Vessel Information

Name of Vessel(*)

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Marine Radio Callsign (i.e. SA Number)

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Make/Model of Vessel

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Vessel Registration

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Length of Vessel

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Colour: Hull

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Type (eg Half Cabin)

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Colour: Topsides

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Make of Engine/s

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Number of Engines

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Horsepower

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Fuel Capacity

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Fuel Type

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Cruising Range

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Vessel Insurance

Vessel Liability Insurer

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Insurance Policy No

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Policy Expiry Date

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Vehicle Information

Vehicle Registration

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Trailer Registration

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Radio Equipment

27 MHz

VHF

2 Meg

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Safety Equipment

Will your vessel carry all Safety Equipment for Open Waters as required by the NSW Maritime Authority for the period of this Temporary Membership?

YES

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Will your vessel carry an in-date 406Mhz Emergency Position Indicating Radio Beacon (EPIRB) for the period of this Temporary Membership?

YES

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Captain’s Details

Postal Address

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Phone Number

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Email Address

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I confirm that the information provided in this form is true and correct. I agree that the participation in club activities is at my own risk and understand that the holding of club activities must not be construed as an invitation to put to sea in conditions beyond the capability of craft and crew. I fully understand that the safety of vessel and crew is the Captain’s responsibility, as is the decision to put to sea.

Captain's Signature

Sign Above

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Date(*)

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Boat Register Information Form

Vessel Information

Vessel Insurance

Vehicle Information

Radio and Navigation Equipment

Safety Equipment

Captain’s Details

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