Nelson Bay Emergency Services and Associates Fishing Club

New Member. [……] Visit our website at www.nelsonbayfishing.com Renewal [……]

Surname …………………………………………………………………………………..

Given Name ……………………………………………………………………………………

Address …………………………………………………………………………………………..

…………………………………………………………………………………………..

Postcode ………………

Occupation ………………………………………………………………………………………………………

Spouse / Contact Name …………………………………………………………..

Birth Date ………………………………………………………… Membership No.. ……………………………….

Home Phone ………………………………………………………… Mobile Phone. ………………………………………..

Business Phone …………………………………………………………. Fax No. ………………………………………………..

E-mail ………………………………………………………………………………………………………………………………………..

Do You wish to register as a small boat owner?. Yes. [……] No…[……]

What kind of boat do you own? ………………………………………………………………………………

I am interested in Rock Fishing Estuary boat fishing Deep Sea fishing Land based estuary fishing Beach fishing

Are you interested in a yearly extended fishing trip away yes no ………………………………………………………………………………………………………………………………………………………….

Membership Fees enclosed being for the current financial year:-

Senior Membership $40.00

Family Membership- mum/dad and two kids u 18 $75.00 Junior Membership- under 18 $20.00 (more than two additional kids $10)

Fees may be payed to any committee member or directly deposited into NSW Police Credit Union Account 271063 (if depositing from a police credit union account please add S1 to the Account Number i.e 271063S1) , BSB 815000. Please include your name in the reference field

I request that you enter my name as a member of the Nelson Bay Emergency Services and Associates Fishing Club. I agree to be bound by the Constitution, Rules, and By-Laws of the Fishing Club together with any Regulations introduced by the Fishing Club Committee from time to time. I further acknowledge and agree that participation in any Fishing Club activities is at my own risk and that the Nelson Bay Emergency Services and Associates Fishing Club, it's committee and or members can in no way be held responsible for any injuries or loss to myself or my property sustained in any way or manner while travelling to or from or in the course of my participation in any such activity.Event participants are warned that involvement in this club or associated activies is a ‘recreational activity’, within the meaning of the Civil Liability Act 2002 and that the pursuit of such activities may result in personal harm or injury. All persons who engage in a recreational activity do so at their own risk. It is the responsibility of the individual to know and ensure that: All State Fishing rules and regulations are adhered to. Vessels are registered, seaworthy and comply strictly with the NSW Waterways legislation for the intended area of operation. Vessels are adequately insured for its intended use against theft, damage, personal injury and liability. Nelson Bay Emergency Services & Associates Fishing Club is a social Fishing Club and participation in club activities are at the members own risk.

Signed Date

______Receipt No. …………………. Issued

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