WEITI BOATING CLUB (INC)

PILE MOORING APPLICATION FORM

1. SURNAME______________________________________________________________

2. CHRISTIAN NAMES______________________________________________________

3. ADDRESS_______________________________________________________________

_______________________________________________________________

4. TELEPHONE: PRIVATE ___________________ BUSINESS _____________________

5. OCCUPATION___________________________________________________________

6. NAME OF BOAT_________________________________________________________

7. TYPE OF BOAT __________________________________________________________

8. LENGTH_________________ BEAM________________ DRAFT__________________

9. ARE YOU A MEMBER OF ANY OTHER BOATING CLUB? Yes/No

Name of Club _________________________________________

10. LOCATION OF PRESENT MOORINGS_______________________________________

Or new boat, yet to be launched? Yes/No

11. INSURANCE DETAILS MUST ACCOMPANY THIS FORM.

NAME OF INSURANCE COMPANY__________________________________________

POLICY NUMBER______________________________EXPIRY DATE______________

(Signature) (Date)

Please fill in above particulars and return to:

The Secretary,

Weiti Boating Club (Inc)

P.O. Box 207,

Whangaparaoa.