Please check your details. If a distress situation occurs, accurate information may be vital to your safety.

(To move from each input box to the next, press the TAB key).

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Member Information				Phones:
Owner:
Postal address:
Home address:
Email address:
Shore Contact/2nd Owner:

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Boat Details
The vessel
How kept:	Moored Berthed On trailer
Dimensions:	(Numbers only)	(Numbers only)	(Numbers)
Colours:
ACMA Callsign:		MMSI:	Vessel usage:   Private Commercial

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Engine Details
Main engine type:	Inboard Outboard Stern Drive none	No. of main engines:	0 1 2 3 4		Fuel:	Diesel Petrol 2-Stroke mix None

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Equipment
Radar:	Y N	EPIRB:	Y N	GPS:	Y N	AIS:	Y N	HF radio:	Y N	VHF radio:	Y N
Defib:	Y N	Aux engine:	Y N	Life raft:	Y N	Dinghy:	Y N	Paddle:	Y N	Flares:	Y N
Fire ext:	Y N	Life jackets:	Y N	Anchor:	Y N	Food/water:	Y N

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Additional Information

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Please double-check your details before going to the next page. Note: Do NOT enter the words metres, HP or knots (we know these already).

If you don't want to submit this form,	Go back

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