Membership application form - Midland Sailing Club

Full name*
Gender*
- Male
- Female
Date of birth*

DD
MM
YYYY
Ethnicity*
Category of membership*
Family members*
Name Gender DoB Ethnicity Disability Regular sailor?

For family members please gives names of all members of the family and dates of birth of children under 18 and those in full time education up to the age of 22.
Home address*
Street Address Address Line 2 City Postcode
Contact telephone (required)*
Email address*
Tell us about your boat(s)
Boat/board type or class Boat name Sail no. Indoor / outdoor storage required?

All dinghies, windsurfers and model yachts brought to Midland Sailing Club must be insured.
How did you hear about us?

Name	Gender	DoB	Ethnicity	Disability	Regular sailor?

Boat/board type or class	Boat name	Sail no.	Indoor / outdoor storage required?